<?=$this->load->view('include_header',null)?>
<style type="text/css">
select { width:100px;}
</style>
	<div id="top-panel">
		<div id="panel">
			<ul>
				<li class="current"><a href="<?=site_url('archive/idcard/'.$id)?>" class="report"><?=(empty($id))?"录入新":"编辑"?>客户基本信息</a></li>
				<?php if(!empty($info->id)):?><li><a id="printInfo" class="folder_table">打印本页信息</a></li><?php endif;?>
			</ul>
		</div>
	</div>
	<div id="wrapper">
		<div id="content">
			<div id="box">
<!-- table begin -->
<form method="post" id="form"  name="f" enctype="multipart/form-data" action="<?=site_url('schengen/ca_update/'.$cateid)?>">

	<h3>加拿大申根表</h3>
    <table width="100%">
    <thead>
        <tr>
          <td colspan="3" align="right"><img src="<?= (@$info->avatar)?@$info->avatar:'images/avatar.gif'?>" width="150" height="150" /></td>
		  <td colspan="2" align="right">
		  上传照片<br />
		  <input type="file" name="userphoto"/><br />
		  (.gif|.jpg|.png文件,最大1M)<br />
		  <?php if (@$info->attachment):?><a href="<?= @$info->attachment?>" target="_blank">点击下载附件</a><?php endif; ?>
		  &nbsp;&nbsp;&nbsp;&nbsp;上传附件<br />
		  <input type="file" name="userfile"/><br />
		  (.pdf|.zip|.rar|.doc,最大2M)		  </td>
        </tr>
    </thead>
    <tfoot>
        <tr>
            <td colspan="5" align="right">			
			<input type="hidden" name="id" value="<?=$id?>" />
			<input id="button1" type="submit" value="提交信息" />
			<input id="button2" type="reset" value="重置" />			</td>
        </tr>
    </tfoot>

    <tbody>
        <tr class="odd">
            <td>UCI/Client ID</td>
        	<td><input type="text" name="uci" value="<?= @$info->uci?>" /></td>
        	<td>&nbsp;</td>
        	<td>I want service in</td>
			<td><select name="service_in">
			    <option></option>	
				<option value="English" <?= (@$info->service_in=='English')?'selected':''?>>English</option>
				<option value="French" <?= (@$info->service_in=='French')?'selected':''?>>French</option>
			</select>			</td>
        </tr>
        <tr class="even">
            <td>Visa Requested </td>
        	<td><select name="visa_requested">
				<option></option>	
				<option value="Single" <?= (@$info->visa_requested=='Single')?'selected':''?>>Single</option>
				<option value="Multiple" <?= (@$info->visa_requested=='Multiple')?'selected':''?>>Multiple</option>
				<option value="Transit" <?= (@$info->visa_requested=='Transit')?'selected':''?>>Transit</option>
			</select></td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td colspan="5">PERSONAL DETAILS</td>
        	</tr>
        <tr class="odd">
            <td>1.Full name<br />
            	Family name (as shown on your passport or travel document) </td>
        	<td><input type="text" name="family_name" value="<?= @$info->family_name?>" /></td>
        	<td>&nbsp;</td>
        	<td>Given name(s) (as shown on your passport or travel document)</td>
			<td><input type="text" name="given_name" value="<?= @$info->given_name?>" /></td>
        </tr>
        <tr class="even">
            <td colspan="4">2.Have you ever used any other name? </td>
        	<td>
			<input type="radio" name="has_other_name" value="0" <?= (@$info->has_other_name==0)?'checked':''?> />No 
        	<input type="radio" name="has_other_name" value="1" <?= (@$info->has_other_name==1)?'checked':''?> />Yes
			</td>
        </tr>
        <tr class="odd">
            <td>Nickname/Alias Family name<br /></td>
        	<td><input type="text" name="alias_family_name" value="<?= @$info->alias_family_name?>" /></td>
        	<td>&nbsp;</td>
        	<td> Given name(s)</td>
			<td><input type="text" name="alias_given_name" value="<?= @$info->alias_given_name?>" /></td>
        </tr>
        <tr class="even">
            <td>3.Sex </td>
        	<td><select name="sex">
				<option></option>	
				<option value="1" <?= (@$info->sex=='1')?'selected':''?>>Male</option>
				<option value="2" <?= (@$info->sex=='2')?'selected':''?>>Female</option>
				<option value="0" <?= (@$info->sex=='0')?'selected':''?>>Unknown</option>
			</select></td>
        	<td>&nbsp;</td>
        	<td>4.Date of birth(
YYYY MM DD)</td>
			<td nowrap="nowrap">
			<select name="birth_y" style="width:auto"><option></option><?php for($i=date("Y");$i>1940;$i--) echo "<option value='$i'".((@$info->birth_y==$i)?" selected":"").">$i</option>"; ?></select>
			<select name="birth_m" style="width:auto"><option></option><?php for($i=1;$i<=12;$i++) echo "<option value='$i'".((@$info->birth_m==$i)?" selected":"").">$i</option>"; ?></select> 
			<select name="birth_d" style="width:auto"><option></option><?php for($i=1;$i<=31;$i++) echo "<option value='$i'".((@$info->birth_d==$i)?" selected":"").">$i</option>"; ?></select>			</td>
        </tr>
        <tr class="odd">
            <td>5.Place of birth 
            	City/Town</td>
        	<td><input type="text" name="birth_place" value="<?= @$info->birth_place?>" /></td>
        	<td>&nbsp;</td>
        	<td> Country</td>
			<td><select name="birth_country">
<option></option>
<option value="Afghanistan"<?= (@$info->birth_country=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->birth_country=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->birth_country=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->birth_country=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->birth_country=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->birth_country=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->birth_country=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->birth_country=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->birth_country=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->birth_country=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->birth_country=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->birth_country=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->birth_country=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->birth_country=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->birth_country=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->birth_country=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->birth_country=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->birth_country=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->birth_country=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->birth_country=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->birth_country=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->birth_country=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->birth_country=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->birth_country=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->birth_country=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->birth_country=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->birth_country=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->birth_country=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->birth_country=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->birth_country=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->birth_country=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->birth_country=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->birth_country=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->birth_country=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->birth_country=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->birth_country=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->birth_country=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->birth_country=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->birth_country=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->birth_country=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->birth_country=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->birth_country=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->birth_country=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->birth_country=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->birth_country=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->birth_country=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->birth_country=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->birth_country=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->birth_country=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->birth_country=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->birth_country=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->birth_country=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->birth_country=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->birth_country=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->birth_country=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->birth_country=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->birth_country=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->birth_country=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->birth_country=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->birth_country=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->birth_country=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->birth_country=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->birth_country=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->birth_country=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->birth_country=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->birth_country=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->birth_country=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->birth_country=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->birth_country=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->birth_country=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->birth_country=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->birth_country=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->birth_country=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->birth_country=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->birth_country=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->birth_country=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->birth_country=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->birth_country=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->birth_country=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->birth_country=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->birth_country=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->birth_country=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->birth_country=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->birth_country=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->birth_country=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->birth_country=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->birth_country=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->birth_country=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->birth_country=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->birth_country=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->birth_country=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->birth_country=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->birth_country=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->birth_country=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->birth_country=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->birth_country=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->birth_country=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->birth_country=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->birth_country=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->birth_country=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->birth_country=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->birth_country=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->birth_country=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->birth_country=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->birth_country=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->birth_country=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->birth_country=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->birth_country=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->birth_country=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->birth_country=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->birth_country=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->birth_country=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->birth_country=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->birth_country=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->birth_country=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->birth_country=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->birth_country=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->birth_country=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->birth_country=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->birth_country=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->birth_country=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->birth_country=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->birth_country=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->birth_country=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->birth_country=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->birth_country=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->birth_country=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->birth_country=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->birth_country=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->birth_country=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->birth_country=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->birth_country=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->birth_country=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->birth_country=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->birth_country=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->birth_country=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->birth_country=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->birth_country=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->birth_country=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->birth_country=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->birth_country=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->birth_country=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->birth_country=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->birth_country=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->birth_country=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->birth_country=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->birth_country=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->birth_country=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->birth_country=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->birth_country=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->birth_country=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->birth_country=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->birth_country=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->birth_country=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->birth_country=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->birth_country=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->birth_country=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->birth_country=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->birth_country=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->birth_country=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->birth_country=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->birth_country=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->birth_country=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->birth_country=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->birth_country=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->birth_country=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->birth_country=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->birth_country=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->birth_country=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->birth_country=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->birth_country=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->birth_country=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->birth_country=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->birth_country=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->birth_country=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->birth_country=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->birth_country=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->birth_country=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->birth_country=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->birth_country=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->birth_country=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->birth_country=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->birth_country=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->birth_country=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->birth_country=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->birth_country=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->birth_country=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->birth_country=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->birth_country=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->birth_country=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->birth_country=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->birth_country=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->birth_country=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->birth_country=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->birth_country=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->birth_country=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->birth_country=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->birth_country=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->birth_country=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->birth_country=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->birth_country=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->birth_country=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->birth_country=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->birth_country=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->birth_country=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->birth_country=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->birth_country=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->birth_country=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->birth_country=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->birth_country=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->birth_country=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->birth_country=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->birth_country=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->birth_country=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->birth_country=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->birth_country=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->birth_country=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->birth_country=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->birth_country=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->birth_country=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->birth_country=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->birth_country=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->birth_country=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->birth_country=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->birth_country=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->birth_country=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->birth_country=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->birth_country=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->birth_country=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->birth_country=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->birth_country=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->birth_country=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->birth_country=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->birth_country=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->birth_country=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->birth_country=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->birth_country=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->birth_country=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->birth_country=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->birth_country=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->birth_country=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->birth_country=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->birth_country=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->birth_country=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select></td>
        </tr>
        <tr class="even">
            <td>6.Citizenship</td>
        	<td><select name="citizenship">
<option></option>			
<option value="Afghanistan"<?= (@$info->citizenship=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->citizenship=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->citizenship=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->citizenship=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->citizenship=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->citizenship=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->citizenship=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->citizenship=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->citizenship=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->citizenship=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->citizenship=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->citizenship=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->citizenship=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->citizenship=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->citizenship=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->citizenship=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->citizenship=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->citizenship=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->citizenship=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->citizenship=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->citizenship=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->citizenship=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->citizenship=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->citizenship=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->citizenship=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->citizenship=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->citizenship=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->citizenship=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->citizenship=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->citizenship=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->citizenship=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->citizenship=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->citizenship=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->citizenship=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->citizenship=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->citizenship=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->citizenship=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->citizenship=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->citizenship=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->citizenship=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->citizenship=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->citizenship=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->citizenship=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->citizenship=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->citizenship=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->citizenship=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->citizenship=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->citizenship=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->citizenship=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->citizenship=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->citizenship=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->citizenship=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->citizenship=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->citizenship=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->citizenship=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->citizenship=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->citizenship=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->citizenship=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->citizenship=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->citizenship=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->citizenship=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->citizenship=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->citizenship=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->citizenship=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->citizenship=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->citizenship=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->citizenship=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->citizenship=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->citizenship=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->citizenship=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->citizenship=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->citizenship=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->citizenship=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->citizenship=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->citizenship=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->citizenship=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->citizenship=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->citizenship=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->citizenship=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->citizenship=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->citizenship=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->citizenship=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->citizenship=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->citizenship=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->citizenship=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->citizenship=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->citizenship=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->citizenship=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->citizenship=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->citizenship=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->citizenship=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->citizenship=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->citizenship=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->citizenship=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->citizenship=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->citizenship=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->citizenship=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->citizenship=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->citizenship=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->citizenship=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->citizenship=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->citizenship=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->citizenship=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->citizenship=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->citizenship=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->citizenship=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->citizenship=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->citizenship=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->citizenship=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->citizenship=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->citizenship=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->citizenship=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->citizenship=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->citizenship=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->citizenship=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->citizenship=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->citizenship=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->citizenship=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->citizenship=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->citizenship=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->citizenship=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->citizenship=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->citizenship=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->citizenship=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->citizenship=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->citizenship=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->citizenship=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->citizenship=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->citizenship=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->citizenship=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->citizenship=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->citizenship=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->citizenship=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->citizenship=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->citizenship=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->citizenship=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->citizenship=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->citizenship=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->citizenship=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->citizenship=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->citizenship=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->citizenship=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->citizenship=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->citizenship=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->citizenship=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->citizenship=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->citizenship=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->citizenship=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->citizenship=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->citizenship=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->citizenship=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->citizenship=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->citizenship=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->citizenship=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->citizenship=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->citizenship=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->citizenship=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->citizenship=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->citizenship=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->citizenship=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->citizenship=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->citizenship=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->citizenship=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->citizenship=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->citizenship=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->citizenship=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->citizenship=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->citizenship=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->citizenship=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->citizenship=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->citizenship=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->citizenship=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->citizenship=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->citizenship=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->citizenship=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->citizenship=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->citizenship=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->citizenship=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->citizenship=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->citizenship=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->citizenship=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->citizenship=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->citizenship=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->citizenship=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->citizenship=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->citizenship=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->citizenship=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->citizenship=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->citizenship=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->citizenship=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->citizenship=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->citizenship=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->citizenship=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->citizenship=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->citizenship=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->citizenship=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->citizenship=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->citizenship=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->citizenship=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->citizenship=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->citizenship=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->citizenship=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->citizenship=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->citizenship=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->citizenship=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->citizenship=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->citizenship=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->citizenship=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->citizenship=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->citizenship=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->citizenship=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->citizenship=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->citizenship=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->citizenship=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->citizenship=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->citizenship=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->citizenship=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->citizenship=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->citizenship=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->citizenship=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->citizenship=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->citizenship=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->citizenship=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->citizenship=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->citizenship=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->citizenship=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->citizenship=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->citizenship=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->citizenship=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->citizenship=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->citizenship=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->citizenship=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->citizenship=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->citizenship=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->citizenship=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->citizenship=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->citizenship=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->citizenship=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->citizenship=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->citizenship=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->citizenship=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->citizenship=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->citizenship=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->citizenship=="Zimbabwe")?" selected":""?>>Zimbabwe</option>

			</select></td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="odd">
            <td colspan="5">7.Current country of residence:</td>
        	</tr>
        <tr class="even">
            <td>Country</td>
        	<td>Status</td>
        	<td>Other</td>
        	<td>From</td>
			<td>To</td>
        </tr>
        <tr class="odd">
            <td><select name="current_country">
<option></option>
<option value="Afghanistan"<?= (@$info->current_country=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->current_country=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->current_country=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->current_country=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->current_country=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->current_country=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->current_country=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->current_country=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->current_country=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->current_country=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->current_country=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->current_country=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->current_country=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->current_country=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->current_country=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->current_country=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->current_country=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->current_country=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->current_country=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->current_country=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->current_country=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->current_country=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->current_country=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->current_country=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->current_country=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->current_country=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->current_country=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->current_country=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->current_country=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->current_country=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->current_country=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->current_country=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->current_country=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->current_country=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->current_country=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->current_country=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->current_country=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->current_country=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->current_country=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->current_country=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->current_country=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->current_country=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->current_country=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->current_country=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->current_country=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->current_country=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->current_country=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->current_country=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->current_country=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->current_country=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->current_country=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->current_country=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->current_country=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->current_country=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->current_country=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->current_country=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->current_country=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->current_country=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->current_country=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->current_country=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->current_country=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->current_country=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->current_country=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->current_country=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->current_country=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->current_country=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->current_country=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->current_country=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->current_country=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->current_country=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->current_country=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->current_country=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->current_country=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->current_country=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->current_country=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->current_country=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->current_country=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->current_country=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->current_country=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->current_country=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->current_country=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->current_country=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->current_country=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->current_country=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->current_country=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->current_country=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->current_country=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->current_country=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->current_country=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->current_country=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->current_country=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->current_country=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->current_country=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->current_country=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->current_country=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->current_country=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->current_country=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->current_country=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->current_country=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->current_country=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->current_country=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->current_country=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->current_country=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->current_country=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->current_country=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->current_country=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->current_country=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->current_country=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->current_country=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->current_country=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->current_country=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->current_country=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->current_country=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->current_country=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->current_country=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->current_country=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->current_country=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->current_country=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->current_country=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->current_country=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->current_country=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->current_country=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->current_country=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->current_country=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->current_country=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->current_country=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->current_country=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->current_country=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->current_country=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->current_country=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->current_country=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->current_country=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->current_country=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->current_country=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->current_country=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->current_country=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->current_country=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->current_country=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->current_country=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->current_country=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->current_country=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->current_country=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->current_country=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->current_country=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->current_country=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->current_country=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->current_country=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->current_country=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->current_country=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->current_country=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->current_country=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->current_country=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->current_country=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->current_country=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->current_country=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->current_country=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->current_country=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->current_country=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->current_country=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->current_country=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->current_country=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->current_country=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->current_country=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->current_country=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->current_country=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->current_country=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->current_country=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->current_country=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->current_country=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->current_country=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->current_country=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->current_country=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->current_country=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->current_country=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->current_country=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->current_country=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->current_country=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->current_country=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->current_country=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->current_country=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->current_country=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->current_country=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->current_country=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->current_country=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->current_country=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->current_country=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->current_country=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->current_country=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->current_country=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->current_country=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->current_country=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->current_country=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->current_country=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->current_country=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->current_country=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->current_country=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->current_country=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->current_country=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->current_country=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->current_country=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->current_country=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->current_country=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->current_country=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->current_country=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->current_country=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->current_country=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->current_country=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->current_country=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->current_country=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->current_country=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->current_country=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->current_country=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->current_country=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->current_country=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->current_country=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->current_country=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->current_country=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->current_country=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->current_country=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->current_country=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->current_country=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->current_country=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->current_country=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->current_country=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->current_country=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->current_country=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->current_country=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->current_country=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->current_country=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->current_country=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->current_country=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->current_country=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->current_country=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->current_country=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->current_country=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->current_country=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->current_country=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->current_country=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->current_country=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->current_country=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->current_country=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->current_country=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->current_country=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->current_country=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
        	<td><select name="current_status">
<option></option>
<option value="Citizen"<?= (@$info->current_status=="Citizen")?" selected":""?>>Citizen</option>
<option value="Permanent resident"<?= (@$info->current_status=="Permanent resident")?" selected":""?>>Permanent resident</option>
<option value="Visitor"<?= (@$info->current_status=="Visitor")?" selected":""?>>Visitor</option>
<option value="Worker"<?= (@$info->current_status=="Worker")?" selected":""?>>Worker</option>
<option value="Student"<?= (@$info->current_status=="Student")?" selected":""?>>Student</option>
<option value="Other"<?= (@$info->current_status=="Other")?" selected":""?>>Other</option>
			</select>
			</td>
        	<td><input type="text" name="current_other" value="<?= @$info->current_other?>" style="width:80px" /></td>
        	<td><input type="text" name="current_from" id="current_from" value="<?= @$info->current_from?>" style="width:80px"/></td>
			<td><input type="text" name="current_to" id="current_to" value="<?= @$info->current_to?>" style="width:80px"/></td>
        </tr>
        <tr class="even">
            <td colspan="5">8.Previous countries of residence: During the past five years have you lived in any country other than your country of citizenship or your current country of residence (indicated above) for more than six months? 
			<input type="radio" name="is_pre_residence" value="0" <?= (@$info->is_pre_residence==0)?'checked':''?> />No 
        	<input type="radio" name="is_pre_residence" value="1" <?= (@$info->is_pre_residence==1)?'checked':''?> />Yes
			</td>
        	</tr>
        <tr class="odd">
            <td>Country</td>
        	<td>Status</td>
        	<td>Other</td>
        	<td>From</td>
			<td>To</td>
        </tr>
        <tr class="even">
            <td><select name="pre_country1">
<option></option>
<option value="Afghanistan"<?= (@$info->pre_country1=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->pre_country1=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->pre_country1=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->pre_country1=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->pre_country1=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->pre_country1=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->pre_country1=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->pre_country1=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->pre_country1=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->pre_country1=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->pre_country1=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->pre_country1=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->pre_country1=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->pre_country1=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->pre_country1=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->pre_country1=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->pre_country1=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->pre_country1=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->pre_country1=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->pre_country1=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->pre_country1=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->pre_country1=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->pre_country1=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->pre_country1=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->pre_country1=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->pre_country1=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->pre_country1=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->pre_country1=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->pre_country1=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->pre_country1=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->pre_country1=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->pre_country1=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->pre_country1=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->pre_country1=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->pre_country1=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->pre_country1=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->pre_country1=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->pre_country1=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->pre_country1=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->pre_country1=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->pre_country1=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->pre_country1=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->pre_country1=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->pre_country1=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->pre_country1=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->pre_country1=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->pre_country1=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->pre_country1=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->pre_country1=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->pre_country1=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->pre_country1=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->pre_country1=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->pre_country1=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->pre_country1=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->pre_country1=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->pre_country1=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->pre_country1=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->pre_country1=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->pre_country1=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->pre_country1=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->pre_country1=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->pre_country1=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->pre_country1=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->pre_country1=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->pre_country1=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->pre_country1=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->pre_country1=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->pre_country1=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->pre_country1=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->pre_country1=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->pre_country1=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->pre_country1=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->pre_country1=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->pre_country1=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->pre_country1=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->pre_country1=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->pre_country1=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->pre_country1=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->pre_country1=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->pre_country1=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->pre_country1=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->pre_country1=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->pre_country1=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->pre_country1=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->pre_country1=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->pre_country1=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->pre_country1=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->pre_country1=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->pre_country1=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->pre_country1=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->pre_country1=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->pre_country1=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->pre_country1=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->pre_country1=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->pre_country1=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->pre_country1=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->pre_country1=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->pre_country1=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->pre_country1=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->pre_country1=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->pre_country1=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->pre_country1=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->pre_country1=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->pre_country1=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->pre_country1=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->pre_country1=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->pre_country1=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->pre_country1=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->pre_country1=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->pre_country1=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->pre_country1=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->pre_country1=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->pre_country1=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->pre_country1=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->pre_country1=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->pre_country1=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->pre_country1=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->pre_country1=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->pre_country1=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->pre_country1=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->pre_country1=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->pre_country1=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->pre_country1=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->pre_country1=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->pre_country1=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->pre_country1=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->pre_country1=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->pre_country1=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->pre_country1=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->pre_country1=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->pre_country1=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->pre_country1=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->pre_country1=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->pre_country1=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->pre_country1=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->pre_country1=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->pre_country1=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->pre_country1=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->pre_country1=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->pre_country1=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->pre_country1=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->pre_country1=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->pre_country1=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->pre_country1=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->pre_country1=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->pre_country1=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->pre_country1=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->pre_country1=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->pre_country1=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->pre_country1=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->pre_country1=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->pre_country1=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->pre_country1=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->pre_country1=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->pre_country1=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->pre_country1=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->pre_country1=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->pre_country1=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->pre_country1=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->pre_country1=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->pre_country1=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->pre_country1=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->pre_country1=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->pre_country1=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->pre_country1=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->pre_country1=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->pre_country1=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->pre_country1=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->pre_country1=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->pre_country1=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->pre_country1=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->pre_country1=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->pre_country1=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->pre_country1=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->pre_country1=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->pre_country1=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->pre_country1=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->pre_country1=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->pre_country1=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->pre_country1=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->pre_country1=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->pre_country1=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->pre_country1=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->pre_country1=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->pre_country1=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->pre_country1=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->pre_country1=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->pre_country1=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->pre_country1=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->pre_country1=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->pre_country1=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->pre_country1=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->pre_country1=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->pre_country1=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->pre_country1=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->pre_country1=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->pre_country1=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->pre_country1=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->pre_country1=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->pre_country1=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->pre_country1=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->pre_country1=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->pre_country1=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->pre_country1=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->pre_country1=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->pre_country1=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->pre_country1=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->pre_country1=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->pre_country1=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->pre_country1=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->pre_country1=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->pre_country1=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->pre_country1=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->pre_country1=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->pre_country1=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->pre_country1=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->pre_country1=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->pre_country1=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->pre_country1=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->pre_country1=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->pre_country1=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->pre_country1=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->pre_country1=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->pre_country1=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->pre_country1=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->pre_country1=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->pre_country1=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->pre_country1=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->pre_country1=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->pre_country1=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->pre_country1=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->pre_country1=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->pre_country1=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->pre_country1=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->pre_country1=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->pre_country1=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->pre_country1=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->pre_country1=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->pre_country1=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->pre_country1=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->pre_country1=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->pre_country1=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->pre_country1=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->pre_country1=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
        	<td><select name="pre_status1">
				<option></option>
				<option value="Citizen"<?= (@$info->pre_status1=="Citizen")?" selected":""?>>Citizen</option>
				<option value="Permanent resident"<?= (@$info->pre_status1=="Permanent resident")?" selected":""?>>Permanent resident</option>
				<option value="Visitor"<?= (@$info->pre_status1=="Visitor")?" selected":""?>>Visitor</option>
				<option value="Worker"<?= (@$info->pre_status1=="Worker")?" selected":""?>>Worker</option>
				<option value="Student"<?= (@$info->pre_status1=="Student")?" selected":""?>>Student</option>
				<option value="Other"<?= (@$info->pre_status1=="Other")?" selected":""?>>Other</option>
			</select></td>
        	<td><input type="text" name="pre_other1" value="<?= @$info->pre_other1?>" style="width:80px" /></td>
        	<td><input type="text" name="pre_from1" id="pre_from1" value="<?= @$info->pre_from1?>" style="width:80px"/></td>
			<td><input type="text" name="pre_to1" id="pre_to1" value="<?= @$info->pre_to1?>" style="width:80px"/></td>
        </tr>
        <tr class="odd">
            <td><select name="pre_country2">
<option></option>
<option value="Afghanistan"<?= (@$info->pre_country2=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->pre_country2=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->pre_country2=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->pre_country2=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->pre_country2=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->pre_country2=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->pre_country2=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->pre_country2=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->pre_country2=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->pre_country2=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->pre_country2=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->pre_country2=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->pre_country2=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->pre_country2=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->pre_country2=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->pre_country2=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->pre_country2=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->pre_country2=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->pre_country2=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->pre_country2=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->pre_country2=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->pre_country2=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->pre_country2=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->pre_country2=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->pre_country2=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->pre_country2=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->pre_country2=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->pre_country2=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->pre_country2=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->pre_country2=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->pre_country2=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->pre_country2=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->pre_country2=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->pre_country2=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->pre_country2=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->pre_country2=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->pre_country2=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->pre_country2=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->pre_country2=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->pre_country2=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->pre_country2=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->pre_country2=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->pre_country2=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->pre_country2=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->pre_country2=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->pre_country2=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->pre_country2=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->pre_country2=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->pre_country2=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->pre_country2=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->pre_country2=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->pre_country2=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->pre_country2=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->pre_country2=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->pre_country2=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->pre_country2=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->pre_country2=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->pre_country2=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->pre_country2=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->pre_country2=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->pre_country2=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->pre_country2=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->pre_country2=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->pre_country2=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->pre_country2=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->pre_country2=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->pre_country2=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->pre_country2=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->pre_country2=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->pre_country2=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->pre_country2=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->pre_country2=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->pre_country2=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->pre_country2=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->pre_country2=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->pre_country2=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->pre_country2=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->pre_country2=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->pre_country2=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->pre_country2=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->pre_country2=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->pre_country2=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->pre_country2=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->pre_country2=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->pre_country2=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->pre_country2=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->pre_country2=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->pre_country2=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->pre_country2=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->pre_country2=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->pre_country2=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->pre_country2=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->pre_country2=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->pre_country2=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->pre_country2=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->pre_country2=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->pre_country2=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->pre_country2=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->pre_country2=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->pre_country2=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->pre_country2=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->pre_country2=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->pre_country2=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->pre_country2=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->pre_country2=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->pre_country2=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->pre_country2=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->pre_country2=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->pre_country2=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->pre_country2=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->pre_country2=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->pre_country2=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->pre_country2=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->pre_country2=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->pre_country2=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->pre_country2=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->pre_country2=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->pre_country2=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->pre_country2=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->pre_country2=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->pre_country2=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->pre_country2=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->pre_country2=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->pre_country2=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->pre_country2=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->pre_country2=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->pre_country2=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->pre_country2=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->pre_country2=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->pre_country2=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->pre_country2=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->pre_country2=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->pre_country2=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->pre_country2=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->pre_country2=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->pre_country2=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->pre_country2=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->pre_country2=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->pre_country2=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->pre_country2=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->pre_country2=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->pre_country2=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->pre_country2=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->pre_country2=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->pre_country2=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->pre_country2=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->pre_country2=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->pre_country2=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->pre_country2=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->pre_country2=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->pre_country2=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->pre_country2=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->pre_country2=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->pre_country2=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->pre_country2=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->pre_country2=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->pre_country2=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->pre_country2=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->pre_country2=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->pre_country2=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->pre_country2=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->pre_country2=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->pre_country2=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->pre_country2=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->pre_country2=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->pre_country2=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->pre_country2=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->pre_country2=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->pre_country2=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->pre_country2=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->pre_country2=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->pre_country2=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->pre_country2=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->pre_country2=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->pre_country2=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->pre_country2=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->pre_country2=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->pre_country2=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->pre_country2=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->pre_country2=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->pre_country2=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->pre_country2=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->pre_country2=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->pre_country2=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->pre_country2=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->pre_country2=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->pre_country2=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->pre_country2=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->pre_country2=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->pre_country2=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->pre_country2=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->pre_country2=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->pre_country2=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->pre_country2=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->pre_country2=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->pre_country2=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->pre_country2=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->pre_country2=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->pre_country2=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->pre_country2=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->pre_country2=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->pre_country2=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->pre_country2=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->pre_country2=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->pre_country2=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->pre_country2=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->pre_country2=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->pre_country2=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->pre_country2=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->pre_country2=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->pre_country2=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->pre_country2=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->pre_country2=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->pre_country2=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->pre_country2=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->pre_country2=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->pre_country2=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->pre_country2=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->pre_country2=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->pre_country2=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->pre_country2=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->pre_country2=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->pre_country2=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->pre_country2=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->pre_country2=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->pre_country2=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->pre_country2=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->pre_country2=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->pre_country2=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->pre_country2=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->pre_country2=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->pre_country2=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->pre_country2=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->pre_country2=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->pre_country2=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->pre_country2=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->pre_country2=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->pre_country2=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->pre_country2=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->pre_country2=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->pre_country2=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->pre_country2=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->pre_country2=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->pre_country2=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
        	<td><select name="pre_status2">
				<option></option>
				<option value="Citizen"<?= (@$info->pre_status2=="Citizen")?" selected":""?>>Citizen</option>
				<option value="Permanent resident"<?= (@$info->pre_status2=="Permanent resident")?" selected":""?>>Permanent resident</option>
				<option value="Visitor"<?= (@$info->pre_status2=="Visitor")?" selected":""?>>Visitor</option>
				<option value="Worker"<?= (@$info->pre_status2=="Worker")?" selected":""?>>Worker</option>
				<option value="Student"<?= (@$info->pre_status2=="Student")?" selected":""?>>Student</option>
				<option value="Other"<?= (@$info->pre_status2=="Other")?" selected":""?>>Other</option>
			</select></td>
        	<td><input type="text" name="pre_other2" value="<?= @$info->pre_other2?>" style="width:80px" /></td>
        	<td><input type="text" name="pre_from2" id="pre_from2" value="<?= @$info->pre_from2?>" style="width:80px"/></td>
			<td><input type="text" name="pre_to2" id="pre_to2" value="<?= @$info->pre_to2?>" style="width:80px"/></td>
        </tr>
        <tr class="even">
            <td colspan="5">9.Country where applying: Same as current country of residence?
			<input type="radio" name="is_same_current" value="0" <?= (@$info->is_same_current==0)?'checked':''?> />No 
        	<input type="radio" name="is_same_current" value="1" <?= (@$info->is_same_current==1)?'checked':''?> />Yes
            </td>
        	</tr>
        <tr class="odd">
            <td>Country</td>
        	<td>Status</td>
        	<td>Other</td>
        	<td>From</td>
			<td>To</td>
        </tr>
        <tr class="even">
            <td><select name="apply_country">
<option></option>
<option value="Afghanistan"<?= (@$info->apply_country=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->apply_country=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->apply_country=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->apply_country=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->apply_country=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->apply_country=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->apply_country=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->apply_country=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->apply_country=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->apply_country=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->apply_country=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->apply_country=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->apply_country=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->apply_country=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->apply_country=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->apply_country=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->apply_country=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->apply_country=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->apply_country=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->apply_country=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->apply_country=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->apply_country=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->apply_country=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->apply_country=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->apply_country=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->apply_country=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->apply_country=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->apply_country=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->apply_country=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->apply_country=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->apply_country=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->apply_country=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->apply_country=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->apply_country=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->apply_country=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->apply_country=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->apply_country=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->apply_country=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->apply_country=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->apply_country=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->apply_country=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->apply_country=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->apply_country=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->apply_country=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->apply_country=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->apply_country=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->apply_country=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->apply_country=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->apply_country=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->apply_country=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->apply_country=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->apply_country=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->apply_country=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->apply_country=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->apply_country=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->apply_country=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->apply_country=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->apply_country=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->apply_country=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->apply_country=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->apply_country=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->apply_country=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->apply_country=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->apply_country=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->apply_country=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->apply_country=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->apply_country=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->apply_country=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->apply_country=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->apply_country=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->apply_country=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->apply_country=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->apply_country=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->apply_country=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->apply_country=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->apply_country=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->apply_country=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->apply_country=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->apply_country=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->apply_country=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->apply_country=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->apply_country=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->apply_country=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->apply_country=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->apply_country=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->apply_country=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->apply_country=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->apply_country=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->apply_country=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->apply_country=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->apply_country=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->apply_country=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->apply_country=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->apply_country=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->apply_country=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->apply_country=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->apply_country=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->apply_country=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->apply_country=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->apply_country=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->apply_country=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->apply_country=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->apply_country=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->apply_country=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->apply_country=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->apply_country=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->apply_country=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->apply_country=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->apply_country=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->apply_country=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->apply_country=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->apply_country=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->apply_country=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->apply_country=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->apply_country=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->apply_country=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->apply_country=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->apply_country=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->apply_country=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->apply_country=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->apply_country=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->apply_country=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->apply_country=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->apply_country=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->apply_country=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->apply_country=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->apply_country=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->apply_country=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->apply_country=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->apply_country=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->apply_country=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->apply_country=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->apply_country=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->apply_country=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->apply_country=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->apply_country=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->apply_country=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->apply_country=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->apply_country=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->apply_country=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->apply_country=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->apply_country=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->apply_country=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->apply_country=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->apply_country=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->apply_country=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->apply_country=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->apply_country=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->apply_country=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->apply_country=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->apply_country=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->apply_country=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->apply_country=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->apply_country=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->apply_country=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->apply_country=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->apply_country=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->apply_country=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->apply_country=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->apply_country=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->apply_country=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->apply_country=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->apply_country=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->apply_country=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->apply_country=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->apply_country=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->apply_country=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->apply_country=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->apply_country=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->apply_country=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->apply_country=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->apply_country=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->apply_country=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->apply_country=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->apply_country=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->apply_country=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->apply_country=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->apply_country=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->apply_country=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->apply_country=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->apply_country=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->apply_country=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->apply_country=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->apply_country=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->apply_country=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->apply_country=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->apply_country=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->apply_country=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->apply_country=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->apply_country=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->apply_country=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->apply_country=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->apply_country=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->apply_country=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->apply_country=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->apply_country=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->apply_country=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->apply_country=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->apply_country=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->apply_country=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->apply_country=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->apply_country=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->apply_country=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->apply_country=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->apply_country=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->apply_country=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->apply_country=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->apply_country=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->apply_country=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->apply_country=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->apply_country=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->apply_country=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->apply_country=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->apply_country=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->apply_country=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->apply_country=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->apply_country=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->apply_country=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->apply_country=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->apply_country=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->apply_country=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->apply_country=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->apply_country=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->apply_country=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->apply_country=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->apply_country=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->apply_country=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->apply_country=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->apply_country=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->apply_country=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->apply_country=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->apply_country=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->apply_country=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->apply_country=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->apply_country=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->apply_country=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->apply_country=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->apply_country=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->apply_country=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->apply_country=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->apply_country=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->apply_country=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->apply_country=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->apply_country=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
        	<td><select name="apply_status">
				<option></option>
				<option value="Citizen"<?= (@$info->apply_status=="Citizen")?" selected":""?>>Citizen</option>
				<option value="Permanent resident"<?= (@$info->apply_status=="Permanent resident")?" selected":""?>>Permanent resident</option>
				<option value="Visitor"<?= (@$info->apply_status=="Visitor")?" selected":""?>>Visitor</option>
				<option value="Worker"<?= (@$info->apply_status=="Worker")?" selected":""?>>Worker</option>
				<option value="Student"<?= (@$info->apply_status=="Student")?" selected":""?>>Student</option>
				<option value="Other"<?= (@$info->apply_status=="Other")?" selected":""?>>Other</option>
			</select></td>
        	<td><input type="text" name="apply_other" value="<?= @$info->apply_other?>" style="width:80px" /></td>
        	<td><input type="text" name="apply_from" id="apply_from" value="<?= @$info->apply_from?>" style="width:80px"/></td>
			<td><input type="text" name="apply_to" id="apply_to" value="<?= @$info->apply_to?>" style="width:80px"/></td>
        </tr>
        <tr class="odd">
            <td>10.a) Your current marital status</td>
        	<td><select name="marital_status">
			<option></option>
			<option value="Annulled Marriage"<?= (@$info->marital_status=="Annulled Marriage")?" selected":""?>>Annulled Marriage</option>
			<option value="Common-Law"<?= (@$info->marital_status=="Common-Law")?" selected":""?>>Common-Law</option>
			<option value="Divorced"<?= (@$info->marital_status=="Divorced")?" selected":""?>>Divorced</option>
			<option value="Legally Separated"<?= (@$info->marital_status=="Legally Separated")?" selected":""?>>Legally Separated</option>
			<option value="Married"<?= (@$info->marital_status=="Married")?" selected":""?>>Married</option>
			<option value="Single"<?= (@$info->marital_status=="Single")?" selected":""?>>Single</option>
			<option value="Widowed"<?= (@$info->marital_status=="Widowed")?" selected":""?>>Widowed</option>
			</select></td>
        	<td>&nbsp;</td>
        	<td>b) (If you are married or in a common-law relationship) Provide the date on which you were married or entered into the common-law relationship</td>
			<td><input type="text" name="marry_date" id="marry_date" value="<?= @$info->marry_date?>" style="width:80px"/></td>
        </tr>
        <tr class="even">
            <td colspan="5">c) Provide the name of your current Spouse/Common-law partner</td>
        	</tr>
        <tr class="odd">
            <td>Family name </td>
        	<td><input type="text" name="spouse_family_name" value="<?= @$info->spouse_family_name?>" /></td>
        	<td>&nbsp;</td>
        	<td>Given name</td>
			<td><input type="text" name="spouse_given_name" value="<?= @$info->spouse_given_name?>" /></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="odd">
            <td colspan="5">11.Have you previously been married or in a common-law relationship? 
			<input type="radio" name="has_pre_married" value="0" <?= (@$info->has_pre_married==0)?'checked':''?> />No 
        	<input type="radio" name="has_pre_married" value="1" <?= (@$info->has_pre_married==1)?'checked':''?> />Yes
			<br />
            	Provide the following details for your previous Spouse/Common-law Partner:</td>
        	</tr>
        <tr class="even">
            <td>Family name</td>
        	<td><input type="text" name="pre_spouse_family_name" value="<?= @$info->pre_spouse_family_name?>" /></td>
        	<td>&nbsp;</td>
        	<td>Given name(s)</td>
			<td><input type="text" name="pre_spouse_given_name" value="<?= @$info->pre_spouse_given_name?>" /></td>
        </tr>
		<tr class="odd">
            <td>Type of relationship</td>
        	<td><select name="pre_married_relationship">
			<option></option>
			<option value="Common-Law"<?= (@$info->pre_married_relationship=="Common-Law")?" selected":""?>>Common-Law</option>
			<option value="Married"<?= (@$info->marital_status=="Married")?" selected":""?>>Married</option>
			</select>
			</td>
        	<td>&nbsp;</td>
        	<td>From<input type="text" name="pre_married_from" id="pre_married_from" value="<?= @$info->pre_married_from?>" style="width:80px"/></td>
			<td>To	<input type="text" name="pre_married_to" id="pre_married_to" value="<?= @$info->pre_married_to?>" style="width:80px"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="5">PASSPORT</td>
        	</tr>
        <tr class="even">
            <td>1.Passport number</td>
        	<td><input type="text" name="passport_no" value="<?= @$info->passport_no?>" /></td>
        	<td>&nbsp;</td>
        	<td>2.Country of issue</td>
			<td><select name="passport_country">
<option></option>
<option value="Afghanistan"<?= (@$info->passport_country=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->passport_country=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->passport_country=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->passport_country=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->passport_country=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->passport_country=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->passport_country=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->passport_country=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->passport_country=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->passport_country=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->passport_country=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->passport_country=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->passport_country=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->passport_country=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->passport_country=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->passport_country=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->passport_country=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->passport_country=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->passport_country=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->passport_country=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->passport_country=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->passport_country=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->passport_country=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->passport_country=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->passport_country=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->passport_country=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->passport_country=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->passport_country=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->passport_country=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->passport_country=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->passport_country=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->passport_country=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->passport_country=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->passport_country=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->passport_country=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->passport_country=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->passport_country=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->passport_country=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->passport_country=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->passport_country=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->passport_country=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->passport_country=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->passport_country=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->passport_country=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->passport_country=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->passport_country=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->passport_country=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->passport_country=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->passport_country=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->passport_country=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->passport_country=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->passport_country=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->passport_country=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->passport_country=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->passport_country=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->passport_country=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->passport_country=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->passport_country=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->passport_country=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->passport_country=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->passport_country=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->passport_country=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->passport_country=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->passport_country=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->passport_country=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->passport_country=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->passport_country=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->passport_country=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->passport_country=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->passport_country=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->passport_country=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->passport_country=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->passport_country=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->passport_country=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->passport_country=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->passport_country=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->passport_country=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->passport_country=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->passport_country=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->passport_country=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->passport_country=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->passport_country=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->passport_country=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->passport_country=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->passport_country=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->passport_country=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->passport_country=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->passport_country=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->passport_country=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->passport_country=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->passport_country=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->passport_country=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->passport_country=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->passport_country=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->passport_country=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->passport_country=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->passport_country=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->passport_country=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->passport_country=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->passport_country=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->passport_country=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->passport_country=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->passport_country=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->passport_country=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->passport_country=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->passport_country=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->passport_country=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->passport_country=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->passport_country=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->passport_country=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->passport_country=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->passport_country=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->passport_country=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->passport_country=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->passport_country=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->passport_country=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->passport_country=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->passport_country=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->passport_country=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->passport_country=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->passport_country=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->passport_country=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->passport_country=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->passport_country=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->passport_country=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->passport_country=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->passport_country=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->passport_country=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->passport_country=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->passport_country=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->passport_country=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->passport_country=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->passport_country=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->passport_country=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->passport_country=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->passport_country=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->passport_country=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->passport_country=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->passport_country=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->passport_country=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->passport_country=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->passport_country=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->passport_country=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->passport_country=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->passport_country=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->passport_country=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->passport_country=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->passport_country=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->passport_country=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->passport_country=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->passport_country=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->passport_country=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->passport_country=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->passport_country=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->passport_country=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->passport_country=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->passport_country=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->passport_country=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->passport_country=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->passport_country=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->passport_country=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->passport_country=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->passport_country=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->passport_country=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->passport_country=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->passport_country=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->passport_country=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->passport_country=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->passport_country=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->passport_country=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->passport_country=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->passport_country=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->passport_country=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->passport_country=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->passport_country=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->passport_country=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->passport_country=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->passport_country=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->passport_country=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->passport_country=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->passport_country=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->passport_country=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->passport_country=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->passport_country=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->passport_country=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->passport_country=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->passport_country=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->passport_country=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->passport_country=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->passport_country=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->passport_country=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->passport_country=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->passport_country=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->passport_country=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->passport_country=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->passport_country=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->passport_country=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->passport_country=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->passport_country=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->passport_country=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->passport_country=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->passport_country=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->passport_country=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->passport_country=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->passport_country=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->passport_country=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->passport_country=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->passport_country=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->passport_country=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->passport_country=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->passport_country=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->passport_country=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->passport_country=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->passport_country=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->passport_country=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->passport_country=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->passport_country=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->passport_country=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->passport_country=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->passport_country=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->passport_country=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->passport_country=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->passport_country=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->passport_country=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->passport_country=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->passport_country=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->passport_country=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->passport_country=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->passport_country=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->passport_country=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->passport_country=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->passport_country=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->passport_country=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->passport_country=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->passport_country=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->passport_country=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->passport_country=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->passport_country=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->passport_country=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->passport_country=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->passport_country=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->passport_country=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->passport_country=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->passport_country=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
        </tr>
		<tr class="odd">
            <td>3.Issue date</td>
        	<td><input type="text" name="passport_issue" id="passport_issue" value="<?= @$info->passport_issue?>" style="width:80px"/></td>
        	<td>&nbsp;</td>
        	<td>4.Expiry date</td>
			<td><input type="text" name="passport_expiry" id="passport_expiry" value="<?= @$info->passport_expiry?>" style="width:80px"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="5">CONTACT INFORMATION</td>
        	</tr>
        <tr class="even">
            <td colspan="5">1.Current mailing address<br />
            	- All correspondence will go to this address unless you indicate your e-mail address below.<br />
            	- Indicating an e-mail address will authorize all correspondence, including file and personal information, to be sent to the e-mail address you specify.<br />
            	- If you wish to authorize the release of information from your application to a representative, indicate their address below and on the IMM5476 form.</td>
        	</tr>
		<tr class="odd">
            <td>P.O. box</td>
        	<td><input type="text" name="mailing_box" value="<?= @$info->mailing_box?>" /></td>
        	<td>&nbsp;</td>
        	<td>Apt/Unit</td>
			<td><input type="text" name="mailing_apt" value="<?= @$info->mailing_apt?>" /></td>
        </tr>
        <tr class="even">
            <td>Street no.</td>
        	<td><input type="text" name="mailing_street_no" value="<?= @$info->mailing_street_no?>" /></td>
        	<td>&nbsp;</td>
        	<td>Street name</td>
			<td><input type="text" name="mailing_street_name" value="<?= @$info->mailing_street_name?>" /></td>
        </tr>
		<tr class="odd">
            <td>City/Town</td>
        	<td><input type="text" name="mailing_city" value="<?= @$info->mailing_city?>" /></td>
        	<td>&nbsp;</td>
        	<td>Country</td>
			<td><select name="mailing_country">
<option></option>
<option value="Afghanistan"<?= (@$info->mailing_country=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->mailing_country=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->mailing_country=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->mailing_country=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->mailing_country=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->mailing_country=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->mailing_country=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->mailing_country=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->mailing_country=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->mailing_country=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->mailing_country=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->mailing_country=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->mailing_country=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->mailing_country=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->mailing_country=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->mailing_country=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->mailing_country=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->mailing_country=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->mailing_country=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->mailing_country=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->mailing_country=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->mailing_country=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->mailing_country=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->mailing_country=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->mailing_country=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->mailing_country=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->mailing_country=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->mailing_country=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->mailing_country=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->mailing_country=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->mailing_country=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->mailing_country=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->mailing_country=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->mailing_country=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->mailing_country=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->mailing_country=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->mailing_country=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->mailing_country=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->mailing_country=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->mailing_country=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->mailing_country=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->mailing_country=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->mailing_country=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->mailing_country=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->mailing_country=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->mailing_country=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->mailing_country=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->mailing_country=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->mailing_country=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->mailing_country=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->mailing_country=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->mailing_country=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->mailing_country=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->mailing_country=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->mailing_country=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->mailing_country=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->mailing_country=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->mailing_country=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->mailing_country=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->mailing_country=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->mailing_country=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->mailing_country=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->mailing_country=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->mailing_country=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->mailing_country=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->mailing_country=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->mailing_country=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->mailing_country=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->mailing_country=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->mailing_country=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->mailing_country=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->mailing_country=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->mailing_country=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->mailing_country=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->mailing_country=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->mailing_country=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->mailing_country=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->mailing_country=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->mailing_country=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->mailing_country=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->mailing_country=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->mailing_country=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->mailing_country=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->mailing_country=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->mailing_country=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->mailing_country=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->mailing_country=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->mailing_country=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->mailing_country=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->mailing_country=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->mailing_country=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->mailing_country=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->mailing_country=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->mailing_country=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->mailing_country=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->mailing_country=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->mailing_country=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->mailing_country=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->mailing_country=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->mailing_country=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->mailing_country=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->mailing_country=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->mailing_country=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->mailing_country=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->mailing_country=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->mailing_country=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->mailing_country=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->mailing_country=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->mailing_country=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->mailing_country=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->mailing_country=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->mailing_country=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->mailing_country=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->mailing_country=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->mailing_country=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->mailing_country=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->mailing_country=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->mailing_country=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->mailing_country=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->mailing_country=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->mailing_country=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->mailing_country=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->mailing_country=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->mailing_country=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->mailing_country=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->mailing_country=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->mailing_country=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->mailing_country=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->mailing_country=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->mailing_country=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->mailing_country=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->mailing_country=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->mailing_country=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->mailing_country=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->mailing_country=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->mailing_country=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->mailing_country=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->mailing_country=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->mailing_country=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->mailing_country=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->mailing_country=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->mailing_country=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->mailing_country=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->mailing_country=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->mailing_country=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->mailing_country=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->mailing_country=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->mailing_country=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->mailing_country=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->mailing_country=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->mailing_country=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->mailing_country=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->mailing_country=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->mailing_country=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->mailing_country=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->mailing_country=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->mailing_country=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->mailing_country=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->mailing_country=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->mailing_country=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->mailing_country=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->mailing_country=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->mailing_country=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->mailing_country=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->mailing_country=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->mailing_country=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->mailing_country=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->mailing_country=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->mailing_country=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->mailing_country=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->mailing_country=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->mailing_country=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->mailing_country=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->mailing_country=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->mailing_country=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->mailing_country=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->mailing_country=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->mailing_country=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->mailing_country=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->mailing_country=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->mailing_country=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->mailing_country=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->mailing_country=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->mailing_country=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->mailing_country=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->mailing_country=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->mailing_country=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->mailing_country=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->mailing_country=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->mailing_country=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->mailing_country=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->mailing_country=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->mailing_country=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->mailing_country=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->mailing_country=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->mailing_country=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->mailing_country=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->mailing_country=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->mailing_country=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->mailing_country=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->mailing_country=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->mailing_country=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->mailing_country=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->mailing_country=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->mailing_country=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->mailing_country=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->mailing_country=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->mailing_country=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->mailing_country=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->mailing_country=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->mailing_country=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->mailing_country=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->mailing_country=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->mailing_country=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->mailing_country=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->mailing_country=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->mailing_country=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->mailing_country=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->mailing_country=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->mailing_country=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->mailing_country=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->mailing_country=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->mailing_country=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->mailing_country=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->mailing_country=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->mailing_country=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->mailing_country=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->mailing_country=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->mailing_country=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->mailing_country=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->mailing_country=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->mailing_country=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->mailing_country=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->mailing_country=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->mailing_country=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->mailing_country=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->mailing_country=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->mailing_country=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->mailing_country=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->mailing_country=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->mailing_country=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->mailing_country=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->mailing_country=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->mailing_country=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
        </tr>
        <tr class="even">
            <td>Province/State</td>
        	<td><input type="text" name="mailing_province" value="<?= @$info->mailing_province?>" /></td>
        	<td>&nbsp;</td>
        	<td>Postal code</td>
			<td><input type="text" name="mailing_postal" value="<?= @$info->mailing_postal?>" /></td>
        </tr>
		<tr class="odd">
            <td>District</td>
        	<td><input type="text" name="mailing_district" value="<?= @$info->mailing_district?>" /></td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td colspan="5">2.Residential address Same as mailing address? 
			<input type="radio" name="is_same_mailing" value="0" <?= (@$info->is_same_mailing==0)?'checked':''?> />No 
        	<input type="radio" name="is_same_mailing" value="1" <?= (@$info->is_same_mailing==1)?'checked':''?> />Yes
			</td>
        	</tr>
		<tr class="odd">
            <td>Apt/Unit</td>
        	<td><input type="text" name="residential_apt" value="<?= @$info->residential_apt?>" /></td>
        	<td>&nbsp;</td>
        	<td>Street no.</td>
			<td><input type="text" name="residential_street_no" value="<?= @$info->residential_street_no?>" /></td>
        </tr>
        <tr class="even">
            <td>Street name</td>
        	<td><input type="text" name="residential_street_name" value="<?= @$info->residential_street_name?>" /></td>
        	<td>&nbsp;</td>
        	<td>City/Town</td>
			<td><input type="text" name="residential_city" value="<?= @$info->residential_city?>" /></td>
        </tr>
		<tr class="odd">
            <td>Country</td>
        	<td><select name="residential_country">
<option></option>
<option value="Afghanistan"<?= (@$info->residential_country=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->residential_country=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->residential_country=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->residential_country=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->residential_country=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->residential_country=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->residential_country=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->residential_country=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->residential_country=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->residential_country=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->residential_country=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->residential_country=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->residential_country=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->residential_country=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->residential_country=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->residential_country=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->residential_country=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->residential_country=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->residential_country=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->residential_country=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->residential_country=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->residential_country=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->residential_country=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->residential_country=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->residential_country=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->residential_country=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->residential_country=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->residential_country=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->residential_country=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->residential_country=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->residential_country=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->residential_country=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->residential_country=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->residential_country=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->residential_country=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->residential_country=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->residential_country=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->residential_country=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->residential_country=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->residential_country=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->residential_country=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->residential_country=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->residential_country=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->residential_country=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->residential_country=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->residential_country=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->residential_country=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->residential_country=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->residential_country=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->residential_country=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->residential_country=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->residential_country=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->residential_country=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->residential_country=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->residential_country=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->residential_country=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->residential_country=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->residential_country=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->residential_country=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->residential_country=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->residential_country=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->residential_country=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->residential_country=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->residential_country=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->residential_country=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->residential_country=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->residential_country=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->residential_country=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->residential_country=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->residential_country=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->residential_country=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->residential_country=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->residential_country=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->residential_country=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->residential_country=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->residential_country=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->residential_country=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->residential_country=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->residential_country=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->residential_country=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->residential_country=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->residential_country=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->residential_country=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->residential_country=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->residential_country=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->residential_country=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->residential_country=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->residential_country=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->residential_country=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->residential_country=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->residential_country=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->residential_country=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->residential_country=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->residential_country=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->residential_country=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->residential_country=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->residential_country=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->residential_country=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->residential_country=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->residential_country=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->residential_country=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->residential_country=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->residential_country=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->residential_country=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->residential_country=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->residential_country=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->residential_country=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->residential_country=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->residential_country=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->residential_country=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->residential_country=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->residential_country=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->residential_country=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->residential_country=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->residential_country=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->residential_country=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->residential_country=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->residential_country=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->residential_country=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->residential_country=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->residential_country=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->residential_country=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->residential_country=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->residential_country=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->residential_country=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->residential_country=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->residential_country=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->residential_country=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->residential_country=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->residential_country=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->residential_country=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->residential_country=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->residential_country=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->residential_country=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->residential_country=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->residential_country=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->residential_country=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->residential_country=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->residential_country=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->residential_country=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->residential_country=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->residential_country=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->residential_country=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->residential_country=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->residential_country=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->residential_country=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->residential_country=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->residential_country=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->residential_country=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->residential_country=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->residential_country=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->residential_country=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->residential_country=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->residential_country=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->residential_country=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->residential_country=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->residential_country=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->residential_country=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->residential_country=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->residential_country=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->residential_country=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->residential_country=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->residential_country=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->residential_country=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->residential_country=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->residential_country=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->residential_country=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->residential_country=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->residential_country=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->residential_country=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->residential_country=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->residential_country=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->residential_country=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->residential_country=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->residential_country=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->residential_country=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->residential_country=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->residential_country=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->residential_country=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->residential_country=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->residential_country=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->residential_country=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->residential_country=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->residential_country=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->residential_country=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->residential_country=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->residential_country=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->residential_country=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->residential_country=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->residential_country=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->residential_country=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->residential_country=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->residential_country=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->residential_country=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->residential_country=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->residential_country=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->residential_country=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->residential_country=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->residential_country=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->residential_country=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->residential_country=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->residential_country=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->residential_country=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->residential_country=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->residential_country=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->residential_country=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->residential_country=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->residential_country=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->residential_country=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->residential_country=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->residential_country=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->residential_country=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->residential_country=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->residential_country=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->residential_country=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->residential_country=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->residential_country=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->residential_country=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->residential_country=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->residential_country=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->residential_country=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->residential_country=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->residential_country=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->residential_country=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->residential_country=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->residential_country=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->residential_country=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->residential_country=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->residential_country=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->residential_country=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->residential_country=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->residential_country=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->residential_country=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->residential_country=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->residential_country=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->residential_country=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->residential_country=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->residential_country=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->residential_country=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->residential_country=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->residential_country=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->residential_country=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->residential_country=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->residential_country=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
        	<td>&nbsp;</td>
        	<td>Province/State</td>
			<td><input type="text" name="residential_province" value="<?= @$info->residential_province?>" /></td>
        </tr>
        <tr class="even">
            <td>Postal code</td>
        	<td><input type="text" name="residential_postal" value="<?= @$info->residential_postal?>" /></td>
        	<td>&nbsp;</td>
        	<td>District</td>
			<td><input type="text" name="residential_district" value="<?= @$info->residential_district?>" /></td>
        </tr>
		<tr class="odd">
            <td colspan="5">3.Telephone no.</td>
        	</tr>
        <tr class="even">
            <td>
			<input type="radio" name="is_na_tel" value="1" <?= (@$info->is_na_tel==1)?'checked':''?> />Canada/US 
        	<input type="radio" name="is_na_tel" value="0" <?= (@$info->is_na_tel==0)?'checked':''?> />Other
			</td>
        	<td colspan="4">Type 
			<select name="tel_type">
			<option></option>
			<option value="Residence"<?= (@$info->tel_type=="Residence")?" selected":""?>>Residence</option>
			<option value="Cellular"<?= (@$info->tel_type=="Cellular")?" selected":""?>>Cellular</option>
			<option value="Business"<?= (@$info->tel_type=="Business")?" selected":""?>>Business</option>
			</select>
			Country Code<input type="text" name="tel_code" value="<?= @$info->tel_code?>" style="width: 25px;" />
			No.<input type="text" name="tel_no" value="<?= @$info->tel_no?>" />
			Ext.<input type="text" name="tel_ext" value="<?= @$info->tel_ext?>" />
			</td>
        	</tr>
		<tr class="odd">
            <td colspan="5">4.Alternate Telephone no.</td>
        	</tr>
        <tr class="even">
            <td>
			<input type="radio" name="is_alter_na_tel" value="1" <?= (@$info->is_alter_na_tel==1)?'checked':''?> />Canada/US 
        	<input type="radio" name="is_alter_na_tel" value="0" <?= (@$info->is_alter_na_tel==0)?'checked':''?> />Other
			</td>
        	<td colspan="4">Type
				<select name="alter_tel_type">
					<option></option>
					<option value="Residence"<?= (@$info->alter_tel_type=="Residence")?" selected":""?>>Residence</option>
					<option value="Cellular"<?= (@$info->alter_tel_type=="Cellular")?" selected":""?>>Cellular</option>
					<option value="Business"<?= (@$info->alter_tel_type=="Business")?" selected":""?>>Business</option>
				</select>
Country Code
<input type="text" name="alter_tel_code" value="<?= @$info->alter_tel_code?>" style="width: 25px;" />
No.
<input type="text" name="alter_tel_no" value="<?= @$info->alter_tel_no?>" />
Ext.
<input type="text" name="alter_tel_ext" value="<?= @$info->alter_tel_ext?>" /></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">5.Fax no.</td>
        	</tr>
        <tr class="even">
            <td>
			<input type="radio" name="is_na_fax" value="1" <?= (@$info->is_na_fax==1)?'checked':''?> />Canada/US 
        	<input type="radio" name="is_na_fax" value="0" <?= (@$info->is_na_fax==0)?'checked':''?> />Other
			</td>
        	<td colspan="4"> Country Code
				<input type="text" name="fax_code" value="<?= @$info->fax_code?>" style="width: 25px;" />
No.
<input type="text" name="fax_no" value="<?= @$info->fax_no?>" />
Ext.
<input type="text" name="fax_ext" value="<?= @$info->fax_ext?>" /></td>
        	</tr>
		<tr class="odd">
            <td>6.E-mail address</td>
        	<td><input type="text" name="email" value="<?= @$info->email?>" id="email" /></td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="5">DETAILS OF VISIT TO CANADA</td>
        	</tr>
        <tr class="even">
            <td>1.a) Purpose of my visit</td>
        	<td><select name="visit_purpose">
			<option></option>
			<option value="Business"<?= (@$info->visit_purpose=="Business")?" selected":""?>>Business</option>
			<option value="Tourism"<?= (@$info->visit_purpose=="Tourism")?" selected":""?>>Tourism</option>
			<option value="Other"<?= (@$info->visit_purpose=="Other")?" selected":""?>>Other</option>
			</select>
			</td>
        	<td>&nbsp;</td>
        	<td>b) Other</td>
			<td><input type="text" name="visit_purpose_other" value="<?= @$info->visit_purpose_other?>" /></td>
        </tr>
		<tr class="odd">
            <td>2.Indicate how long<br />
            	you plan to stay From <br /></td>
        	<td><input type="text" name="visit_from" id="visit_from" value="<?= @$info->visit_from?>" style="width:80px"/></td>
        	<td>&nbsp;</td>
        	<td>To</td>
			<td><input type="text" name="visit_to" id="visit_to" value="<?= @$info->visit_to?>" style="width:80px"/></td>
        </tr>
        <tr class="even">
            <td>3.Funds available for my stay (CAD)</td>
        	<td><input type="text" name="visit_cad" value="<?= @$info->visit_cad?>" /></td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="5">4.Name, address and relationship of any person(s) or institution(s) I will visit:</td>
        	</tr>
        <tr class="even">
            <td>1)Name</td>
        	<td><input type="text" name="visit_person_name1" value="<?= @$info->visit_person_name1?>" /></td>
        	<td>&nbsp;</td>
        	<td>Relationship to me</td>
			<td><input type="text" name="visit_person_relate1" value="<?= @$info->visit_person_relate1?>" /></td>
        </tr>
		<tr class="odd">
            <td>Address in Canada</td>
        	<td colspan="4"><input type="text" name="visit_person_address1" value="<?= @$info->visit_person_address1?>" /></td>
        	</tr>
        <tr class="even">
            <td>2)Name</td>
        	<td><input type="text" name="visit_person_name2" value="<?= @$info->visit_person_name2?>" /></td>
        	<td>&nbsp;</td>
        	<td>Relationship to me</td>
			<td><input type="text" name="visit_person_relate2" value="<?= @$info->visit_person_relate2?>" /></td>
        </tr>
		<tr class="odd">
            <td>Address in Canada</td>
        	<td colspan="4"><input type="text" name="visit_person_address2" value="<?= @$info->visit_person_address2?>" /></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td colspan="5">EDUCATION</td>
        	</tr>
		<tr class="odd">
            <td colspan="5">Have you had any post secondary education (including university, college or apprenticeship training)?
			<input type="radio" name="has_edu" value="0" <?= (@$info->has_edu==0)?'checked':''?> />No 
        	<input type="radio" name="has_edu" value="1" <?= (@$info->has_edu==1)?'checked':''?> />Yes
			<br />
            	If you answered ‘‘yes’’, give full details of your highest level of post secondary education.</td>
        	</tr>
        <tr class="even">
            <td>From<br />
            	YYYY<input type="text" name="edu_from_y" value="<?= @$info->edu_from_y?>" style="width:30px" /> MM<input type="text" name="edu_from_m" value="<?= @$info->edu_from_m?>" style="width:15px" /></td>
        	<td>Field of study<br />
			<input type="text" name="edu_field" value="<?= @$info->edu_field?>" />
			</td>
        	<td>&nbsp;</td>
        	<td>School/Facility name<br />
			<input type="text" name="edu_school" value="<?= @$info->edu_school?>" />
			</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td>To<br />
            	YYYY<input type="text" name="edu_to_y" value="<?= @$info->edu_to_y?>" style="width:30px" />
				MM<input type="text" name="edu_to_m" value="<?= @$info->edu_to_m?>" style="width:15px" /></td>
        	<td>City/Town
        		<br />
        		<input type="text" name="edu_city" value="<?= @$info->edu_city?>" /></td>
        	<td>&nbsp;</td>
        	<td>Country<br />
			<select name="edu_country">
<option></option>
<option value="Afghanistan"<?= (@$info->edu_country=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->edu_country=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->edu_country=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->edu_country=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->edu_country=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->edu_country=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->edu_country=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->edu_country=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->edu_country=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->edu_country=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->edu_country=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->edu_country=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->edu_country=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->edu_country=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->edu_country=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->edu_country=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->edu_country=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->edu_country=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->edu_country=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->edu_country=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->edu_country=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->edu_country=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->edu_country=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->edu_country=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->edu_country=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->edu_country=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->edu_country=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->edu_country=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->edu_country=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->edu_country=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->edu_country=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->edu_country=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->edu_country=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->edu_country=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->edu_country=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->edu_country=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->edu_country=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->edu_country=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->edu_country=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->edu_country=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->edu_country=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->edu_country=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->edu_country=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->edu_country=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->edu_country=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->edu_country=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->edu_country=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->edu_country=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->edu_country=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->edu_country=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->edu_country=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->edu_country=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->edu_country=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->edu_country=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->edu_country=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->edu_country=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->edu_country=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->edu_country=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->edu_country=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->edu_country=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->edu_country=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->edu_country=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->edu_country=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->edu_country=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->edu_country=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->edu_country=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->edu_country=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->edu_country=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->edu_country=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->edu_country=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->edu_country=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->edu_country=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->edu_country=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->edu_country=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->edu_country=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->edu_country=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->edu_country=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->edu_country=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->edu_country=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->edu_country=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->edu_country=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->edu_country=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->edu_country=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->edu_country=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->edu_country=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->edu_country=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->edu_country=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->edu_country=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->edu_country=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->edu_country=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->edu_country=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->edu_country=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->edu_country=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->edu_country=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->edu_country=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->edu_country=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->edu_country=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->edu_country=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->edu_country=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->edu_country=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->edu_country=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->edu_country=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->edu_country=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->edu_country=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->edu_country=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->edu_country=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->edu_country=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->edu_country=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->edu_country=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->edu_country=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->edu_country=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->edu_country=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->edu_country=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->edu_country=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->edu_country=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->edu_country=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->edu_country=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->edu_country=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->edu_country=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->edu_country=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->edu_country=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->edu_country=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->edu_country=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->edu_country=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->edu_country=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->edu_country=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->edu_country=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->edu_country=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->edu_country=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->edu_country=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->edu_country=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->edu_country=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->edu_country=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->edu_country=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->edu_country=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->edu_country=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->edu_country=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->edu_country=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->edu_country=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->edu_country=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->edu_country=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->edu_country=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->edu_country=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->edu_country=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->edu_country=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->edu_country=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->edu_country=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->edu_country=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->edu_country=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->edu_country=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->edu_country=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->edu_country=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->edu_country=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->edu_country=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->edu_country=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->edu_country=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->edu_country=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->edu_country=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->edu_country=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->edu_country=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->edu_country=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->edu_country=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->edu_country=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->edu_country=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->edu_country=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->edu_country=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->edu_country=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->edu_country=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->edu_country=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->edu_country=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->edu_country=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->edu_country=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->edu_country=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->edu_country=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->edu_country=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->edu_country=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->edu_country=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->edu_country=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->edu_country=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->edu_country=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->edu_country=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->edu_country=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->edu_country=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->edu_country=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->edu_country=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->edu_country=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->edu_country=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->edu_country=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->edu_country=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->edu_country=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->edu_country=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->edu_country=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->edu_country=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->edu_country=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->edu_country=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->edu_country=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->edu_country=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->edu_country=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->edu_country=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->edu_country=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->edu_country=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->edu_country=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->edu_country=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->edu_country=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->edu_country=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->edu_country=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->edu_country=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->edu_country=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->edu_country=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->edu_country=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->edu_country=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->edu_country=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->edu_country=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->edu_country=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->edu_country=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->edu_country=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->edu_country=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->edu_country=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->edu_country=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->edu_country=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->edu_country=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->edu_country=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->edu_country=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->edu_country=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->edu_country=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->edu_country=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->edu_country=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->edu_country=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->edu_country=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->edu_country=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->edu_country=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->edu_country=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->edu_country=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->edu_country=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->edu_country=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->edu_country=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->edu_country=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->edu_country=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->edu_country=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->edu_country=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->edu_country=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->edu_country=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->edu_country=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->edu_country=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
			<td>Province/State
				<br />
				<input type="text" name="edu_province" value="<?= @$info->edu_province?>" /></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="5">EMPLOYMENT</td>
        	</tr>
        <tr class="even">
            <td colspan="5">Give details of your employment for the past 10 years. If retired, not working, or studying, please indicate. If you are retired, provide the 10 years before your retirement.</td>
        	</tr>
		<tr class="odd">
            <td>1)From<br />
            	YYYY
            	<input type="text" name="emp_from_y1" value="<?= @$info->emp_from_y1?>" style="width:30px" />
MM
<input type="text" name="emp_from_m1" value="<?= @$info->emp_from_m1?>" style="width:15px" /></td>
        	<td>Current Activity/Occupation
        		<br />
        		<input type="text" name="emp_occup1" value="<?= @$info->emp_occup1?>" /></td>
        	<td>&nbsp;</td>
        	<td>Company/Employer/Facility name
        		<br />
        		<input type="text" name="emp_company1" value="<?= @$info->emp_company1?>" /></td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>To<br />
            	YYYY
            	<input type="text" name="emp_to_y1" value="<?= @$info->emp_to_y1?>" style="width:30px" />
MM
<input type="text" name="emp_to_m1" value="<?= @$info->emp_to_m1?>" style="width:15px" /></td>
        	<td>City/Town
        		<br />
        		<input type="text" name="emp_city1" value="<?= @$info->emp_city1?>" /></td>
        	<td>&nbsp;</td>
        	<td>Country<br />
			<select name="emp_country1">
<option></option>
<option value="Afghanistan"<?= (@$info->emp_country1=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->emp_country1=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->emp_country1=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->emp_country1=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->emp_country1=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->emp_country1=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->emp_country1=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->emp_country1=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->emp_country1=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->emp_country1=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->emp_country1=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->emp_country1=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->emp_country1=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->emp_country1=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->emp_country1=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->emp_country1=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->emp_country1=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->emp_country1=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->emp_country1=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->emp_country1=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->emp_country1=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->emp_country1=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->emp_country1=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->emp_country1=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->emp_country1=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->emp_country1=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->emp_country1=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->emp_country1=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->emp_country1=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->emp_country1=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->emp_country1=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->emp_country1=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->emp_country1=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->emp_country1=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->emp_country1=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->emp_country1=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->emp_country1=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->emp_country1=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->emp_country1=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->emp_country1=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->emp_country1=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->emp_country1=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->emp_country1=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->emp_country1=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->emp_country1=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->emp_country1=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->emp_country1=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->emp_country1=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->emp_country1=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->emp_country1=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->emp_country1=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->emp_country1=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->emp_country1=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->emp_country1=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->emp_country1=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->emp_country1=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->emp_country1=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->emp_country1=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->emp_country1=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->emp_country1=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->emp_country1=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->emp_country1=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->emp_country1=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->emp_country1=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->emp_country1=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->emp_country1=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->emp_country1=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->emp_country1=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->emp_country1=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->emp_country1=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->emp_country1=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->emp_country1=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->emp_country1=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->emp_country1=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->emp_country1=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->emp_country1=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->emp_country1=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->emp_country1=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->emp_country1=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->emp_country1=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->emp_country1=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->emp_country1=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->emp_country1=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->emp_country1=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->emp_country1=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->emp_country1=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->emp_country1=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->emp_country1=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->emp_country1=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->emp_country1=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->emp_country1=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->emp_country1=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->emp_country1=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->emp_country1=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->emp_country1=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->emp_country1=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->emp_country1=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->emp_country1=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->emp_country1=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->emp_country1=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->emp_country1=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->emp_country1=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->emp_country1=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->emp_country1=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->emp_country1=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->emp_country1=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->emp_country1=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->emp_country1=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->emp_country1=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->emp_country1=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->emp_country1=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->emp_country1=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->emp_country1=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->emp_country1=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->emp_country1=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->emp_country1=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->emp_country1=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->emp_country1=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->emp_country1=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->emp_country1=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->emp_country1=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->emp_country1=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->emp_country1=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->emp_country1=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->emp_country1=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->emp_country1=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->emp_country1=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->emp_country1=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->emp_country1=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->emp_country1=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->emp_country1=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->emp_country1=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->emp_country1=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->emp_country1=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->emp_country1=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->emp_country1=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->emp_country1=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->emp_country1=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->emp_country1=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->emp_country1=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->emp_country1=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->emp_country1=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->emp_country1=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->emp_country1=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->emp_country1=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->emp_country1=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->emp_country1=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->emp_country1=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->emp_country1=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->emp_country1=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->emp_country1=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->emp_country1=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->emp_country1=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->emp_country1=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->emp_country1=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->emp_country1=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->emp_country1=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->emp_country1=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->emp_country1=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->emp_country1=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->emp_country1=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->emp_country1=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->emp_country1=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->emp_country1=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->emp_country1=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->emp_country1=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->emp_country1=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->emp_country1=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->emp_country1=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->emp_country1=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->emp_country1=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->emp_country1=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->emp_country1=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->emp_country1=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->emp_country1=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->emp_country1=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->emp_country1=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->emp_country1=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->emp_country1=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->emp_country1=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->emp_country1=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->emp_country1=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->emp_country1=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->emp_country1=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->emp_country1=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->emp_country1=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->emp_country1=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->emp_country1=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->emp_country1=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->emp_country1=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->emp_country1=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->emp_country1=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->emp_country1=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->emp_country1=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->emp_country1=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->emp_country1=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->emp_country1=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->emp_country1=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->emp_country1=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->emp_country1=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->emp_country1=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->emp_country1=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->emp_country1=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->emp_country1=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->emp_country1=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->emp_country1=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->emp_country1=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->emp_country1=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->emp_country1=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->emp_country1=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->emp_country1=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->emp_country1=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->emp_country1=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->emp_country1=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->emp_country1=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->emp_country1=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->emp_country1=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->emp_country1=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->emp_country1=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->emp_country1=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->emp_country1=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->emp_country1=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->emp_country1=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->emp_country1=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->emp_country1=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->emp_country1=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->emp_country1=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->emp_country1=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->emp_country1=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->emp_country1=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->emp_country1=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->emp_country1=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->emp_country1=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->emp_country1=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->emp_country1=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->emp_country1=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->emp_country1=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->emp_country1=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->emp_country1=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->emp_country1=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->emp_country1=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->emp_country1=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->emp_country1=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->emp_country1=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
			<td>Province/State
				<br />
				<input type="text" name="emp_province1" value="<?= @$info->emp_province1?>" /></td>
        </tr>
		<tr class="odd">
            <td>2)From<br />
YYYY
            	<input type="text" name="emp_from_y2" value="<?= @$info->emp_from_y2?>" style="width:30px" />
MM
<input type="text" name="emp_from_m2" value="<?= @$info->emp_from_m2?>" style="width:15px" /></td>
        	<td>Current Activity/Occupation
        		<input type="text" name="emp_occup2" value="<?= @$info->emp_occup2?>" /></td>
        	<td>&nbsp;</td>
        	<td>Company/Employer/Facility name
        		<input type="text" name="emp_company2" value="<?= @$info->emp_company2?>" /></td>
        	<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>To<br />
YYYY
            	<input type="text" name="emp_to_y2" value="<?= @$info->emp_to_y2?>" style="width:30px" />
MM
<input type="text" name="emp_to_m2" value="<?= @$info->emp_to_m2?>" style="width:15px" /></td>
        	<td>City/Town
        		<br />
        		<input type="text" name="emp_city2" value="<?= @$info->emp_city2?>" /></td>
        	<td>&nbsp;</td>
        	<td>Country<br />
			<select name="emp_country2">
<option></option>
<option value="Afghanistan"<?= (@$info->emp_country2=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->emp_country2=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->emp_country2=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->emp_country2=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->emp_country2=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->emp_country2=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->emp_country2=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->emp_country2=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->emp_country2=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->emp_country2=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->emp_country2=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->emp_country2=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->emp_country2=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->emp_country2=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->emp_country2=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->emp_country2=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->emp_country2=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->emp_country2=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->emp_country2=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->emp_country2=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->emp_country2=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->emp_country2=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->emp_country2=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->emp_country2=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->emp_country2=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->emp_country2=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->emp_country2=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->emp_country2=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->emp_country2=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->emp_country2=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->emp_country2=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->emp_country2=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->emp_country2=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->emp_country2=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->emp_country2=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->emp_country2=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->emp_country2=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->emp_country2=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->emp_country2=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->emp_country2=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->emp_country2=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->emp_country2=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->emp_country2=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->emp_country2=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->emp_country2=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->emp_country2=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->emp_country2=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->emp_country2=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->emp_country2=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->emp_country2=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->emp_country2=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->emp_country2=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->emp_country2=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->emp_country2=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->emp_country2=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->emp_country2=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->emp_country2=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->emp_country2=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->emp_country2=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->emp_country2=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->emp_country2=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->emp_country2=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->emp_country2=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->emp_country2=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->emp_country2=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->emp_country2=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->emp_country2=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->emp_country2=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->emp_country2=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->emp_country2=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->emp_country2=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->emp_country2=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->emp_country2=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->emp_country2=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->emp_country2=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->emp_country2=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->emp_country2=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->emp_country2=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->emp_country2=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->emp_country2=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->emp_country2=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->emp_country2=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->emp_country2=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->emp_country2=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->emp_country2=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->emp_country2=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->emp_country2=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->emp_country2=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->emp_country2=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->emp_country2=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->emp_country2=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->emp_country2=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->emp_country2=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->emp_country2=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->emp_country2=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->emp_country2=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->emp_country2=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->emp_country2=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->emp_country2=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->emp_country2=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->emp_country2=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->emp_country2=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->emp_country2=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->emp_country2=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->emp_country2=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->emp_country2=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->emp_country2=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->emp_country2=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->emp_country2=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->emp_country2=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->emp_country2=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->emp_country2=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->emp_country2=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->emp_country2=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->emp_country2=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->emp_country2=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->emp_country2=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->emp_country2=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->emp_country2=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->emp_country2=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->emp_country2=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->emp_country2=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->emp_country2=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->emp_country2=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->emp_country2=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->emp_country2=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->emp_country2=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->emp_country2=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->emp_country2=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->emp_country2=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->emp_country2=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->emp_country2=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->emp_country2=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->emp_country2=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->emp_country2=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->emp_country2=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->emp_country2=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->emp_country2=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->emp_country2=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->emp_country2=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->emp_country2=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->emp_country2=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->emp_country2=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->emp_country2=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->emp_country2=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->emp_country2=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->emp_country2=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->emp_country2=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->emp_country2=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->emp_country2=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->emp_country2=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->emp_country2=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->emp_country2=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->emp_country2=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->emp_country2=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->emp_country2=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->emp_country2=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->emp_country2=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->emp_country2=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->emp_country2=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->emp_country2=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->emp_country2=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->emp_country2=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->emp_country2=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->emp_country2=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->emp_country2=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->emp_country2=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->emp_country2=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->emp_country2=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->emp_country2=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->emp_country2=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->emp_country2=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->emp_country2=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->emp_country2=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->emp_country2=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->emp_country2=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->emp_country2=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->emp_country2=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->emp_country2=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->emp_country2=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->emp_country2=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->emp_country2=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->emp_country2=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->emp_country2=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->emp_country2=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->emp_country2=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->emp_country2=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->emp_country2=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->emp_country2=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->emp_country2=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->emp_country2=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->emp_country2=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->emp_country2=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->emp_country2=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->emp_country2=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->emp_country2=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->emp_country2=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->emp_country2=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->emp_country2=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->emp_country2=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->emp_country2=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->emp_country2=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->emp_country2=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->emp_country2=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->emp_country2=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->emp_country2=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->emp_country2=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->emp_country2=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->emp_country2=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->emp_country2=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->emp_country2=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->emp_country2=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->emp_country2=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->emp_country2=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->emp_country2=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->emp_country2=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->emp_country2=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->emp_country2=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->emp_country2=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->emp_country2=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->emp_country2=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->emp_country2=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->emp_country2=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->emp_country2=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->emp_country2=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->emp_country2=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->emp_country2=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->emp_country2=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->emp_country2=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->emp_country2=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->emp_country2=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->emp_country2=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->emp_country2=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->emp_country2=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->emp_country2=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->emp_country2=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->emp_country2=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->emp_country2=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->emp_country2=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->emp_country2=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->emp_country2=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->emp_country2=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->emp_country2=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->emp_country2=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
        	<td>Province/State
        		<br />
        		<input type="text" name="emp_province2" value="<?= @$info->emp_province2?>" /></td>
        </tr>
		<tr class="odd">
            <td>3)From<br />
YYYY
            	<input type="text" name="emp_from_y3" value="<?= @$info->emp_from_y3?>" style="width:30px" />
MM
<input type="text" name="emp_from_m3" value="<?= @$info->emp_from_m3?>" style="width:15px" /></td>
        	<td>Current Activity/Occupation
        		<input type="text" name="emp_occup3" value="<?= @$info->emp_occup3?>" /></td>
        	<td>&nbsp;</td>
        	<td>Company/Employer/Facility name
        		<input type="text" name="emp_company3" value="<?= @$info->emp_company3?>" /></td>
        	<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>To<br />
YYYY
            	<input type="text" name="emp_to_y3" value="<?= @$info->emp_to_y3?>" style="width:30px" />
MM
<input type="text" name="emp_to_m3" value="<?= @$info->emp_to_m3?>" style="width:15px" /></td>
        	<td>City/Town
        		<br />
        		<input type="text" name="emp_city3" value="<?= @$info->emp_city3?>" /></td>
        	<td>&nbsp;</td>
        	<td>Country<br />
			<select name="emp_country3">
<option></option>
<option value="Afghanistan"<?= (@$info->emp_country3=="Afghanistan")?" selected":""?>>Afghanistan</option>
<option value="Albania"<?= (@$info->emp_country3=="Albania")?" selected":""?>>Albania</option>
<option value="Algeria"<?= (@$info->emp_country3=="Algeria")?" selected":""?>>Algeria</option>
<option value="Andorra"<?= (@$info->emp_country3=="Andorra")?" selected":""?>>Andorra</option>
<option value="Angola"<?= (@$info->emp_country3=="Angola")?" selected":""?>>Angola</option>
<option value="Anguilla"<?= (@$info->emp_country3=="Anguilla")?" selected":""?>>Anguilla</option>
<option value="Antigua And Barbuda"<?= (@$info->emp_country3=="Antigua And Barbuda")?" selected":""?>>Antigua And Barbuda</option>
<option value="Argentina"<?= (@$info->emp_country3=="Argentina")?" selected":""?>>Argentina</option>
<option value="Armenia"<?= (@$info->emp_country3=="Armenia")?" selected":""?>>Armenia</option>
<option value="Aruba"<?= (@$info->emp_country3=="Aruba")?" selected":""?>>Aruba</option>
<option value="Australia"<?= (@$info->emp_country3=="Australia")?" selected":""?>>Australia</option>
<option value="Austria"<?= (@$info->emp_country3=="Austria")?" selected":""?>>Austria</option>
<option value="Azerbaijan"<?= (@$info->emp_country3=="Azerbaijan")?" selected":""?>>Azerbaijan</option>
<option value="Azores"<?= (@$info->emp_country3=="Azores")?" selected":""?>>Azores</option>
<option value="Bahama Islands, The"<?= (@$info->emp_country3=="Bahama Islands, The")?" selected":""?>>Bahama Islands, The</option>
<option value="Bahrain"<?= (@$info->emp_country3=="Bahrain")?" selected":""?>>Bahrain</option>
<option value="Bangladesh"<?= (@$info->emp_country3=="Bangladesh")?" selected":""?>>Bangladesh</option>
<option value="Barbados"<?= (@$info->emp_country3=="Barbados")?" selected":""?>>Barbados</option>
<option value="Belarus"<?= (@$info->emp_country3=="Belarus")?" selected":""?>>Belarus</option>
<option value="Belgium"<?= (@$info->emp_country3=="Belgium")?" selected":""?>>Belgium</option>
<option value="Belize"<?= (@$info->emp_country3=="Belize")?" selected":""?>>Belize</option>
<option value="Benin, Peoples Republic Of"<?= (@$info->emp_country3=="Benin, Peoples Republic Of")?" selected":""?>>Benin, Peoples Republic Of</option>
<option value="Bermuda"<?= (@$info->emp_country3=="Bermuda")?" selected":""?>>Bermuda</option>
<option value="Bhutan"<?= (@$info->emp_country3=="Bhutan")?" selected":""?>>Bhutan</option>
<option value="Bolivia"<?= (@$info->emp_country3=="Bolivia")?" selected":""?>>Bolivia</option>
<option value="Bosnia-Hercepovina"<?= (@$info->emp_country3=="Bosnia-Hercepovina")?" selected":""?>>Bosnia-Hercepovina</option>
<option value="Botswana, Republic Of"<?= (@$info->emp_country3=="Botswana, Republic Of")?" selected":""?>>Botswana, Republic Of</option>
<option value="Brazil"<?= (@$info->emp_country3=="Brazil")?" selected":""?>>Brazil</option>
<option value="Brunei"<?= (@$info->emp_country3=="Brunei")?" selected":""?>>Brunei</option>
<option value="Bulgaria"<?= (@$info->emp_country3=="Bulgaria")?" selected":""?>>Bulgaria</option>
<option value="Burkina Faso"<?= (@$info->emp_country3=="Burkina Faso")?" selected":""?>>Burkina Faso</option>
<option value="Burundi"<?= (@$info->emp_country3=="Burundi")?" selected":""?>>Burundi</option>
<option value="Cambodia"<?= (@$info->emp_country3=="Cambodia")?" selected":""?>>Cambodia</option>
<option value="Cameroon, Federal Republic Of"<?= (@$info->emp_country3=="Cameroon, Federal Republic Of")?" selected":""?>>Cameroon, Federal Republic Of</option>
<option value="Canada"<?= (@$info->emp_country3=="Canada")?" selected":""?>>Canada</option>
<option value="Canary Islands"<?= (@$info->emp_country3=="Canary Islands")?" selected":""?>>Canary Islands</option>
<option value="Cape Verde Islands"<?= (@$info->emp_country3=="Cape Verde Islands")?" selected":""?>>Cape Verde Islands</option>
<option value="Cayman Islands"<?= (@$info->emp_country3=="Cayman Islands")?" selected":""?>>Cayman Islands</option>
<option value="Central Africa Republic"<?= (@$info->emp_country3=="Central Africa Republic")?" selected":""?>>Central Africa Republic</option>
<option value="Chad, Republic Of"<?= (@$info->emp_country3=="Chad, Republic Of")?" selected":""?>>Chad, Republic Of</option>
<option value="Channel Islands"<?= (@$info->emp_country3=="Channel Islands")?" selected":""?>>Channel Islands</option>
<option value="Chile"<?= (@$info->emp_country3=="Chile")?" selected":""?>>Chile</option>
<option value="China, People's Republic Of"<?= (@$info->emp_country3=="China, People's Republic Of")?" selected":""?>>China, People's Republic Of</option>
<option value="Colombia"<?= (@$info->emp_country3=="Colombia")?" selected":""?>>Colombia</option>
<option value="Comoros"<?= (@$info->emp_country3=="Comoros")?" selected":""?>>Comoros</option>
<option value="Congo, People's Republic Of"<?= (@$info->emp_country3=="Congo, People's Republic Of")?" selected":""?>>Congo, People's Republic Of</option>
<option value="Congo, Democratic Republic Of"<?= (@$info->emp_country3=="Congo, Democratic Republic Of")?" selected":""?>>Congo, Democratic Republic Of</option>
<option value="Cook Islands"<?= (@$info->emp_country3=="Cook Islands")?" selected":""?>>Cook Islands</option>
<option value="Costa Rica"<?= (@$info->emp_country3=="Costa Rica")?" selected":""?>>Costa Rica</option>
<option value="Croatia"<?= (@$info->emp_country3=="Croatia")?" selected":""?>>Croatia</option>
<option value="Cuba"<?= (@$info->emp_country3=="Cuba")?" selected":""?>>Cuba</option>
<option value="Cyprus"<?= (@$info->emp_country3=="Cyprus")?" selected":""?>>Cyprus</option>
<option value="Czech Republic"<?= (@$info->emp_country3=="Czech Republic")?" selected":""?>>Czech Republic</option>
<option value="Czechoslovakia"<?= (@$info->emp_country3=="Czechoslovakia")?" selected":""?>>Czechoslovakia</option>
<option value="Denmark"<?= (@$info->emp_country3=="Denmark")?" selected":""?>>Denmark</option>
<option value="Djibouti, Republic Of"<?= (@$info->emp_country3=="Djibouti, Republic Of")?" selected":""?>>Djibouti, Republic Of</option>
<option value="Dominica"<?= (@$info->emp_country3=="Dominica")?" selected":""?>>Dominica</option>
<option value="Dominican Republic"<?= (@$info->emp_country3=="Dominican Republic")?" selected":""?>>Dominican Republic</option>
<option value="East Timor"<?= (@$info->emp_country3=="East Timor")?" selected":""?>>East Timor</option>
<option value="Ecuador"<?= (@$info->emp_country3=="Ecuador")?" selected":""?>>Ecuador</option>
<option value="Egypt"<?= (@$info->emp_country3=="Egypt")?" selected":""?>>Egypt</option>
<option value="El Salvador"<?= (@$info->emp_country3=="El Salvador")?" selected":""?>>El Salvador</option>
<option value="England"<?= (@$info->emp_country3=="England")?" selected":""?>>England</option>
<option value="Eritrea"<?= (@$info->emp_country3=="Eritrea")?" selected":""?>>Eritrea</option>
<option value="Estonia"<?= (@$info->emp_country3=="Estonia")?" selected":""?>>Estonia</option>
<option value="Ethiopia"<?= (@$info->emp_country3=="Ethiopia")?" selected":""?>>Ethiopia</option>
<option value="Falkland Islands"<?= (@$info->emp_country3=="Falkland Islands")?" selected":""?>>Falkland Islands</option>
<option value="Federated States of Micronesia"<?= (@$info->emp_country3=="Federated States of Micronesia")?" selected":""?>>Federated States of Micronesia</option>
<option value="Fiji"<?= (@$info->emp_country3=="Fiji")?" selected":""?>>Fiji</option>
<option value="Finland"<?= (@$info->emp_country3=="Finland")?" selected":""?>>Finland</option>
<option value="France"<?= (@$info->emp_country3=="France")?" selected":""?>>France</option>
<option value="French Guiana"<?= (@$info->emp_country3=="French Guiana")?" selected":""?>>French Guiana</option>
<option value="French Polynesia"<?= (@$info->emp_country3=="French Polynesia")?" selected":""?>>French Polynesia</option>
<option value="Fyr Macedonia"<?= (@$info->emp_country3=="Fyr Macedonia")?" selected":""?>>Fyr Macedonia</option>
<option value="Gabon Republic"<?= (@$info->emp_country3=="Gabon Republic")?" selected":""?>>Gabon Republic</option>
<option value="Gambia"<?= (@$info->emp_country3=="Gambia")?" selected":""?>>Gambia</option>
<option value="Georgia"<?= (@$info->emp_country3=="Georgia")?" selected":""?>>Georgia</option>
<option value="Germany, Federal Rebpublic Of"<?= (@$info->emp_country3=="Germany, Federal Rebpublic Of")?" selected":""?>>Germany, Federal Rebpublic Of</option>
<option value="Ghana"<?= (@$info->emp_country3=="Ghana")?" selected":""?>>Ghana</option>
<option value="Gibraltar"<?= (@$info->emp_country3=="Gibraltar")?" selected":""?>>Gibraltar</option>
<option value="Greece"<?= (@$info->emp_country3=="Greece")?" selected":""?>>Greece</option>
<option value="Greenland"<?= (@$info->emp_country3=="Greenland")?" selected":""?>>Greenland</option>
<option value="Grenada"<?= (@$info->emp_country3=="Grenada")?" selected":""?>>Grenada</option>
<option value="Guadeloupe"<?= (@$info->emp_country3=="Guadeloupe")?" selected":""?>>Guadeloupe</option>
<option value="Guam"<?= (@$info->emp_country3=="Guam")?" selected":""?>>Guam</option>
<option value="Guatemala"<?= (@$info->emp_country3=="Guatemala")?" selected":""?>>Guatemala</option>
<option value="Guinea, Equatorial"<?= (@$info->emp_country3=="Guinea, Equatorial")?" selected":""?>>Guinea, Equatorial</option>
<option value="Guinea, Republic Of"<?= (@$info->emp_country3=="Guinea, Republic Of")?" selected":""?>>Guinea, Republic Of</option>
<option value="Guinea-Bissau"<?= (@$info->emp_country3=="Guinea-Bissau")?" selected":""?>>Guinea-Bissau</option>
<option value="Guyana"<?= (@$info->emp_country3=="Guyana")?" selected":""?>>Guyana</option>
<option value="Haiti"<?= (@$info->emp_country3=="Haiti")?" selected":""?>>Haiti</option>
<option value="Holy See"<?= (@$info->emp_country3=="Holy See")?" selected":""?>>Holy See</option>
<option value="Honduras"<?= (@$info->emp_country3=="Honduras")?" selected":""?>>Honduras</option>
<option value="Hong Kong"<?= (@$info->emp_country3=="Hong Kong")?" selected":""?>>Hong Kong</option>
<option value="Hong Kong Sar"<?= (@$info->emp_country3=="Hong Kong Sar")?" selected":""?>>Hong Kong Sar</option>
<option value="Hungary"<?= (@$info->emp_country3=="Hungary")?" selected":""?>>Hungary</option>
<option value="Iceland"<?= (@$info->emp_country3=="Iceland")?" selected":""?>>Iceland</option>
<option value="India"<?= (@$info->emp_country3=="India")?" selected":""?>>India</option>
<option value="Indonesia, Republic Of"<?= (@$info->emp_country3=="Indonesia, Republic Of")?" selected":""?>>Indonesia, Republic Of</option>
<option value="Iran"<?= (@$info->emp_country3=="Iran")?" selected":""?>>Iran</option>
<option value="Iraq"<?= (@$info->emp_country3=="Iraq")?" selected":""?>>Iraq</option>
<option value="Ireland, Republic Of"<?= (@$info->emp_country3=="Ireland, Republic Of")?" selected":""?>>Ireland, Republic Of</option>
<option value="Israel"<?= (@$info->emp_country3=="Israel")?" selected":""?>>Israel</option>
<option value="Italy"<?= (@$info->emp_country3=="Italy")?" selected":""?>>Italy</option>
<option value="Ivory Coast, Republic"<?= (@$info->emp_country3=="Ivory Coast, Republic")?" selected":""?>>Ivory Coast, Republic</option>
<option value="Jamaica"<?= (@$info->emp_country3=="Jamaica")?" selected":""?>>Jamaica</option>
<option value="Japan"<?= (@$info->emp_country3=="Japan")?" selected":""?>>Japan</option>
<option value="Jordan"<?= (@$info->emp_country3=="Jordan")?" selected":""?>>Jordan</option>
<option value="Kazakhstan"<?= (@$info->emp_country3=="Kazakhstan")?" selected":""?>>Kazakhstan</option>
<option value="Kenya"<?= (@$info->emp_country3=="Kenya")?" selected":""?>>Kenya</option>
<option value="Kiribati"<?= (@$info->emp_country3=="Kiribati")?" selected":""?>>Kiribati</option>
<option value="Korea (North)"<?= (@$info->emp_country3=="Korea (North)")?" selected":""?>>Korea (North)</option>
<option value="Korea, Republic Of"<?= (@$info->emp_country3=="Korea, Republic Of")?" selected":""?>>Korea, Republic Of</option>
<option value="Kuwait"<?= (@$info->emp_country3=="Kuwait")?" selected":""?>>Kuwait</option>
<option value="Kyrgyzstan"<?= (@$info->emp_country3=="Kyrgyzstan")?" selected":""?>>Kyrgyzstan</option>
<option value="Laos"<?= (@$info->emp_country3=="Laos")?" selected":""?>>Laos</option>
<option value="Latvia"<?= (@$info->emp_country3=="Latvia")?" selected":""?>>Latvia</option>
<option value="Lebanon"<?= (@$info->emp_country3=="Lebanon")?" selected":""?>>Lebanon</option>
<option value="Lesotho"<?= (@$info->emp_country3=="Lesotho")?" selected":""?>>Lesotho</option>
<option value="Liberia"<?= (@$info->emp_country3=="Liberia")?" selected":""?>>Liberia</option>
<option value="Libya"<?= (@$info->emp_country3=="Libya")?" selected":""?>>Libya</option>
<option value="Liechtenstein"<?= (@$info->emp_country3=="Liechtenstein")?" selected":""?>>Liechtenstein</option>
<option value="Lithuania"<?= (@$info->emp_country3=="Lithuania")?" selected":""?>>Lithuania</option>
<option value="Luxembourg"<?= (@$info->emp_country3=="Luxembourg")?" selected":""?>>Luxembourg</option>
<option value="Macao"<?= (@$info->emp_country3=="Macao")?" selected":""?>>Macao</option>
<option value="Macau SAR"<?= (@$info->emp_country3=="Macau SAR")?" selected":""?>>Macau SAR</option>
<option value="Madagascar"<?= (@$info->emp_country3=="Madagascar")?" selected":""?>>Madagascar</option>
<option value="Madeira"<?= (@$info->emp_country3=="Madeira")?" selected":""?>>Madeira</option>
<option value="Malawi"<?= (@$info->emp_country3=="Malawi")?" selected":""?>>Malawi</option>
<option value="Malaysia"<?= (@$info->emp_country3=="Malaysia")?" selected":""?>>Malaysia</option>
<option value="Maldives, Republic Of"<?= (@$info->emp_country3=="Maldives, Republic Of")?" selected":""?>>Maldives, Republic Of</option>
<option value="Mali, Republic Of"<?= (@$info->emp_country3=="Mali, Republic Of")?" selected":""?>>Mali, Republic Of</option>
<option value="Malta"<?= (@$info->emp_country3=="Malta")?" selected":""?>>Malta</option>
<option value="Marshall Islands"<?= (@$info->emp_country3=="Marshall Islands")?" selected":""?>>Marshall Islands</option>
<option value="Martinique"<?= (@$info->emp_country3=="Martinique")?" selected":""?>>Martinique</option>
<option value="Mauritania"<?= (@$info->emp_country3=="Mauritania")?" selected":""?>>Mauritania</option>
<option value="Mauritius"<?= (@$info->emp_country3=="Mauritius")?" selected":""?>>Mauritius</option>
<option value="Mayotte"<?= (@$info->emp_country3=="Mayotte")?" selected":""?>>Mayotte</option>
<option value="Mexico"<?= (@$info->emp_country3=="Mexico")?" selected":""?>>Mexico</option>
<option value="Moldova"<?= (@$info->emp_country3=="Moldova")?" selected":""?>>Moldova</option>
<option value="Monaco"<?= (@$info->emp_country3=="Monaco")?" selected":""?>>Monaco</option>
<option value="Mongolia, People's Republic Of"<?= (@$info->emp_country3=="Mongolia, People's Republic Of")?" selected":""?>>Mongolia, People's Republic Of</option>
<option value="Montenegro, Republic Of"<?= (@$info->emp_country3=="Montenegro, Republic Of")?" selected":""?>>Montenegro, Republic Of</option>
<option value="Montserrat"<?= (@$info->emp_country3=="Montserrat")?" selected":""?>>Montserrat</option>
<option value="Morocco"<?= (@$info->emp_country3=="Morocco")?" selected":""?>>Morocco</option>
<option value="Monzambique"<?= (@$info->emp_country3=="Monzambique")?" selected":""?>>Monzambique</option>
<option value="Myanmar (Burma)"<?= (@$info->emp_country3=="Myanmar (Burma)")?" selected":""?>>Myanmar (Burma)</option>
<option value="Namibia"<?= (@$info->emp_country3=="Namibia")?" selected":""?>>Namibia</option>
<option value="Nauru"<?= (@$info->emp_country3=="Nauru")?" selected":""?>>Nauru</option>
<option value="Nepal"<?= (@$info->emp_country3=="Nepal")?" selected":""?>>Nepal</option>
<option value="Netherlands Antilles, The"<?= (@$info->emp_country3=="Netherlands Antilles, The")?" selected":""?>>Netherlands Antilles, The</option>
<option value="Netherlands, The"<?= (@$info->emp_country3=="Netherlands, The")?" selected":""?>>Netherlands, The</option>
<option value="Nevis"<?= (@$info->emp_country3=="Nevis")?" selected":""?>>Nevis</option>
<option value="New Caledonia"<?= (@$info->emp_country3=="New Caledonia")?" selected":""?>>New Caledonia</option>
<option value="New Zealand"<?= (@$info->emp_country3=="New Zealand")?" selected":""?>>New Zealand</option>
<option value="Nicaragua"<?= (@$info->emp_country3=="Nicaragua")?" selected":""?>>Nicaragua</option>
<option value="Niger, Republic Of The"<?= (@$info->emp_country3=="Niger, Republic Of The")?" selected":""?>>Niger, Republic Of The</option>
<option value="Nigeria"<?= (@$info->emp_country3=="Nigeria")?" selected":""?>>Nigeria</option>
<option value="Northern Ireland"<?= (@$info->emp_country3=="Northern Ireland")?" selected":""?>>Northern Ireland</option>
<option value="Northern Mariana Islands"<?= (@$info->emp_country3=="Northern Mariana Islands")?" selected":""?>>Northern Mariana Islands</option>
<option value="Norway"<?= (@$info->emp_country3=="Norway")?" selected":""?>>Norway</option>
<option value="Oman"<?= (@$info->emp_country3=="Oman")?" selected":""?>>Oman</option>
<option value="Pakistan"<?= (@$info->emp_country3=="Pakistan")?" selected":""?>>Pakistan</option>
<option value="Palestinian Autho.Gaza/W Bank"<?= (@$info->emp_country3=="Palestinian Autho.Gaza/W Bank")?" selected":""?>>Palestinian Autho.Gaza/W Bank</option>
<option value="Panama, Republic Of"<?= (@$info->emp_country3=="Panama, Republic Of")?" selected":""?>>Panama, Republic Of</option>
<option value="Papua New Guinea"<?= (@$info->emp_country3=="Papua New Guinea")?" selected":""?>>Papua New Guinea</option>
<option value="Paraguay"<?= (@$info->emp_country3=="Paraguay")?" selected":""?>>Paraguay</option>
<option value="Peru"<?= (@$info->emp_country3=="Peru")?" selected":""?>>Peru</option>
<option value="Philippines"<?= (@$info->emp_country3=="Philippines")?" selected":""?>>Philippines</option>
<option value="Pitcairn Island"<?= (@$info->emp_country3=="Pitcairn Island")?" selected":""?>>Pitcairn Island</option>
<option value="poland"<?= (@$info->emp_country3=="poland")?" selected":""?>>poland</option>
<option value="Portugal"<?= (@$info->emp_country3=="Portugal")?" selected":""?>>Portugal</option>
<option value="Puerto Rico"<?= (@$info->emp_country3=="Puerto Rico")?" selected":""?>>Puerto Rico</option>
<option value="Qatar"<?= (@$info->emp_country3=="Qatar")?" selected":""?>>Qatar</option>
<option value="Republic Of Kosovo"<?= (@$info->emp_country3=="Republic Of Kosovo")?" selected":""?>>Republic Of Kosovo</option>
<option value="Republic Of Palau"<?= (@$info->emp_country3=="Republic Of Palau")?" selected":""?>>Republic Of Palau</option>
<option value="Reunion"<?= (@$info->emp_country3=="Reunion")?" selected":""?>>Reunion</option>
<option value="Romania"<?= (@$info->emp_country3=="Romania")?" selected":""?>>Romania</option>
<option value="Russia"<?= (@$info->emp_country3=="Russia")?" selected":""?>>Russia</option>
<option value="Rwanda"<?= (@$info->emp_country3=="Rwanda")?" selected":""?>>Rwanda</option>
<option value="Samoa, American"<?= (@$info->emp_country3=="Samoa, American")?" selected":""?>>Samoa, American</option>
<option value="Samoa, Western"<?= (@$info->emp_country3=="Samoa, Western")?" selected":""?>>Samoa, Western</option>
<option value="San Marino"<?= (@$info->emp_country3=="San Marino")?" selected":""?>>San Marino</option>
<option value="Sao Tome E Principe"<?= (@$info->emp_country3=="Sao Tome E Principe")?" selected":""?>>Sao Tome E Principe</option>
<option value="Saudi Arabia"<?= (@$info->emp_country3=="Saudi Arabia")?" selected":""?>>Saudi Arabia</option>
<option value="Scotland"<?= (@$info->emp_country3=="Scotland")?" selected":""?>>Scotland</option>
<option value="Senegal"<?= (@$info->emp_country3=="Senegal")?" selected":""?>>Senegal</option>
<option value="Serbia And Montenegro"<?= (@$info->emp_country3=="Serbia And Montenegro")?" selected":""?>>Serbia And Montenegro</option>
<option value="Serbia, Republic Of"<?= (@$info->emp_country3=="Serbia, Republic Of")?" selected":""?>>Serbia, Republic Of</option>
<option value="Seychelles"<?= (@$info->emp_country3=="Seychelles")?" selected":""?>>Seychelles</option>
<option value="Sierra Leone"<?= (@$info->emp_country3=="Sierra Leone")?" selected":""?>>Sierra Leone</option>
<option value="Singapore"<?= (@$info->emp_country3=="Singapore")?" selected":""?>>Singapore</option>
<option value="Slovak Republic"<?= (@$info->emp_country3=="Slovak Republic")?" selected":""?>>Slovak Republic</option>
<option value="Slovenia"<?= (@$info->emp_country3=="Slovenia")?" selected":""?>>Slovenia</option>
<option value="Solomons, The"<?= (@$info->emp_country3=="Solomons, The")?" selected":""?>>Solomons, The</option>
<option value="Somali Republic"<?= (@$info->emp_country3=="Somali Republic")?" selected":""?>>Somali Republic</option>
<option value="South Africa, Republic Of"<?= (@$info->emp_country3=="South Africa, Republic Of")?" selected":""?>>South Africa, Republic Of</option>
<option value="Southern Antarctic Territories"<?= (@$info->emp_country3=="Southern Antarctic Territories")?" selected":""?>>Southern Antarctic Territories</option>
<option value="Spain"<?= (@$info->emp_country3=="Spain")?" selected":""?>>Spain</option>
<option value="Sri Lanka"<?= (@$info->emp_country3=="Sri Lanka")?" selected":""?>>Sri Lanka</option>
<option value="St. Helena"<?= (@$info->emp_country3=="St. Helena")?" selected":""?>>St. Helena</option>
<option value="St. Kitts-Nevis"<?= (@$info->emp_country3=="St. Kitts-Nevis")?" selected":""?>>St. Kitts-Nevis</option>
<option value="St. Lucia"<?= (@$info->emp_country3=="St. Lucia")?" selected":""?>>St. Lucia</option>
<option value="St. Pierre Et Miquelon"<?= (@$info->emp_country3=="St. Pierre Et Miquelon")?" selected":""?>>St. Pierre Et Miquelon</option>
<option value="St. Vincent and the Grenadines"<?= (@$info->emp_country3=="St. Vincent and the Grenadines")?" selected":""?>>St. Vincent and the Grenadines</option>
<option value="Sudan, Democratic Republic Of"<?= (@$info->emp_country3=="Sudan, Democratic Republic Of")?" selected":""?>>Sudan, Democratic Republic Of</option>
<option value="Surinam"<?= (@$info->emp_country3=="Surinam")?" selected":""?>>Surinam</option>
<option value="Swaziland"<?= (@$info->emp_country3=="Swaziland")?" selected":""?>>Swaziland</option>
<option value="Sweden"<?= (@$info->emp_country3=="Sweden")?" selected":""?>>Sweden</option>
<option value="Switzerland"<?= (@$info->emp_country3=="Switzerland")?" selected":""?>>Switzerland</option>
<option value="Syria"<?= (@$info->emp_country3=="Syria")?" selected":""?>>Syria</option>
<option value="Tadjikistan"<?= (@$info->emp_country3=="Tadjikistan")?" selected":""?>>Tadjikistan</option>
<option value="Taiwan"<?= (@$info->emp_country3=="Taiwan")?" selected":""?>>Taiwan</option>
<option value="Tanzania, United Republic Of"<?= (@$info->emp_country3=="Tanzania, United Republic Of")?" selected":""?>>Tanzania, United Republic Of</option>
<option value="Thailand"<?= (@$info->emp_country3=="Thailand")?" selected":""?>>Thailand</option>
<option value="Tibet"<?= (@$info->emp_country3=="Tibet")?" selected":""?>>Tibet</option>
<option value="Togo, Republic Of"<?= (@$info->emp_country3=="Togo, Republic Of")?" selected":""?>>Togo, Republic Of</option>
<option value="Tonga"<?= (@$info->emp_country3=="Tonga")?" selected":""?>>Tonga</option>
<option value="Trinidad & Tobago, Republic Of"<?= (@$info->emp_country3=="Trinidad & Tobago, Republic Of")?" selected":""?>>Trinidad & Tobago, Republic Of</option>
<option value="Tunisia"<?= (@$info->emp_country3=="Tunisia")?" selected":""?>>Tunisia</option>
<option value="Turkey"<?= (@$info->emp_country3=="Turkey")?" selected":""?>>Turkey</option>
<option value="Turkmenistan"<?= (@$info->emp_country3=="Turkmenistan")?" selected":""?>>Turkmenistan</option>
<option value="Turks And Caicos Islands"<?= (@$info->emp_country3=="Turks And Caicos Islands")?" selected":""?>>Turks And Caicos Islands</option>
<option value="Tuvalu"<?= (@$info->emp_country3=="Tuvalu")?" selected":""?>>Tuvalu</option>
<option value="Uganda"<?= (@$info->emp_country3=="Uganda")?" selected":""?>>Uganda</option>
<option value="Ukraine"<?= (@$info->emp_country3=="Ukraine")?" selected":""?>>Ukraine</option>
<option value="Union Of Soviet Socialist Rep"<?= (@$info->emp_country3=="Union Of Soviet Socialist Rep")?" selected":""?>>Union Of Soviet Socialist Rep</option>
<option value="united Arab Emirates"<?= (@$info->emp_country3=="united Arab Emirates")?" selected":""?>>united Arab Emirates</option>
<option value="United States of America"<?= (@$info->emp_country3=="United States of America")?" selected":""?>>United States of America</option>
<option value="Unknown"<?= (@$info->emp_country3=="Unknown")?" selected":""?>>Unknown</option>
<option value="Uruguay"<?= (@$info->emp_country3=="Uruguay")?" selected":""?>>Uruguay</option>
<option value="Uzbekistan"<?= (@$info->emp_country3=="Uzbekistan")?" selected":""?>>Uzbekistan</option>
<option value="Vanuatu"<?= (@$info->emp_country3=="Vanuatu")?" selected":""?>>Vanuatu</option>
<option value="Venezuela"<?= (@$info->emp_country3=="Venezuela")?" selected":""?>>Venezuela</option>
<option value="Vietnam, Socialist Republic Of"<?= (@$info->emp_country3=="Vietnam, Socialist Republic Of")?" selected":""?>>Vietnam, Socialist Republic Of</option>
<option value="Virgin Islands, British"<?= (@$info->emp_country3=="Virgin Islands, British")?" selected":""?>>Virgin Islands, British</option>
<option value="Virgin Islands, U.s."<?= (@$info->emp_country3=="Virgin Islands, U.s.")?" selected":""?>>Virgin Islands, U.s.</option>
<option value="Wales"<?= (@$info->emp_country3=="Wales")?" selected":""?>>Wales</option>
<option value="Wallis And Futuna"<?= (@$info->emp_country3=="Wallis And Futuna")?" selected":""?>>Wallis And Futuna</option>
<option value="Western Sahara"<?= (@$info->emp_country3=="Western Sahara")?" selected":""?>>Western Sahara</option>
<option value="Yemen, Republic Of"<?= (@$info->emp_country3=="Yemen, Republic Of")?" selected":""?>>Yemen, Republic Of</option>
<option value="Yugoslavia"<?= (@$info->emp_country3=="Yugoslavia")?" selected":""?>>Yugoslavia</option>
<option value="Zambia"<?= (@$info->emp_country3=="Zambia")?" selected":""?>>Zambia</option>
<option value="Zimbabwe"<?= (@$info->emp_country3=="Zimbabwe")?" selected":""?>>Zimbabwe</option>
			</select>
			</td>
        	<td>Province/State
        		<br />
        		<input type="text" name="emp_province3" value="<?= @$info->emp_province3?>" /></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td colspan="5">BACKGROUND INFORMATION<br />
            	You must complete this section if you are 18 years of age or older.</td>
        	</tr>
		<tr class="odd">
            <td colspan="4">1.a) Within the past two years, have you or a family member ever had tuberculosis of the lungs or been in close contact with a person with tuberculosis?</td>
        	<td>
			<input type="radio" name="has_tuberculosis" value="0" <?= (@$info->has_tuberculosis==0)?'checked':''?> />No 
        	<input type="radio" name="has_tuberculosis" value="1" <?= (@$info->has_tuberculosis==1)?'checked':''?> />Yes
			</td>
        </tr>
        <tr class="even">
            <td colspan="4">b) Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada?</td>
        	<td>
			<input type="radio" name="has_physical" value="0" <?= (@$info->has_physical==0)?'checked':''?> />No 
        	<input type="radio" name="has_physical" value="1" <?= (@$info->has_physical==1)?'checked':''?> />Yes
			</td>
        </tr>
		<tr class="odd">
            <td colspan="5">c) If you answered &quot;yes&quot; to question 1a) or 1b), please provide details and the name of the family member (if applicable).</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><textarea name="physical_detail"><?= @$info->physical_detail?></textarea></td>
        	</tr>
		<tr class="odd">
            <td colspan="4">2.a) Have you ever previously applied for any Canadian visas (For example: Permanent Resident, Temporary Resident (Visitor, Student, Worker),
            	Temporary Resident Permit)?</td>
        	<td>
			<input type="radio" name="has_applied" value="0" <?= (@$info->has_applied==0)?'checked':''?> />No 
        	<input type="radio" name="has_applied" value="1" <?= (@$info->has_applied==1)?'checked':''?> />Yes
			</td>
        </tr>
        <tr class="even">
            <td colspan="4">b) Have you ever been refused any kind of visa to travel to Canada?</td>
        	<td>
			<input type="radio" name="has_refused" value="0" <?= (@$info->has_refused==0)?'checked':''?> />No 
        	<input type="radio" name="has_refused" value="1" <?= (@$info->has_refused==1)?'checked':''?> />Yes
			</td>
        </tr>
		<tr class="odd">
            <td colspan="4">c) Have you ever been refused admission or been ordered to leave Canada or any other country?</td>
        	<td>
			<input type="radio" name="has_leave" value="0" <?= (@$info->has_leave==0)?'checked':''?> />No 
        	<input type="radio" name="has_leave" value="1" <?= (@$info->has_leave==1)?'checked':''?> />Yes
			</td>
        </tr>
        <tr class="even">
            <td colspan="5">d) If you answered &quot;yes&quot; to question 2a), 2b), or 2c) please provide details.</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><textarea name="apply_detail"><?= @$info->apply_detail?></textarea></td>
        	</tr>
        <tr class="even">
            <td colspan="4">3.Have you ever committed, been arrested for or been charged with any criminal offence in any country? <br /></td>
        	<td>
			<input type="radio" name="has_criminal" value="0" <?= (@$info->has_criminal==0)?'checked':''?> />No 
        	<input type="radio" name="has_criminal" value="1" <?= (@$info->has_criminal==1)?'checked':''?> />Yes
			</td>
        </tr>
		<tr class="odd">
            <td colspan="4">4.a) Have you ever been in a military, militia or civil defence unit or the police?</td>
        	<td>
			<input type="radio" name="has_service" value="0" <?= (@$info->has_service==0)?'checked':''?> />No 
        	<input type="radio" name="has_service" value="1" <?= (@$info->has_service==1)?'checked':''?> />Yes
			</td>
        </tr>
        <tr class="even">
            <td colspan="5">b) If you answered “yes” to question 4a), please provide dates of service and countries where you served.</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><textarea name="service_detail"><?= @$info->service_detail?></textarea></td>
        	</tr>
        <tr class="even">
            <td colspan="4">5.Have you ever been employed by a government in a security-related capacity?</td>
        	<td>
			<input type="radio" name="has_security" value="0" <?= (@$info->has_security==0)?'checked':''?> />No 
        	<input type="radio" name="has_security" value="1" <?= (@$info->has_security==1)?'checked':''?> />Yes
			</td>
        </tr>
		<tr class="odd">
            <td colspan="4">6.Have you ever held a position of authority in any government, or judiciary or a political party?</td>
        	<td>
			<input type="radio" name="has_authority" value="0" <?= (@$info->has_authority==0)?'checked':''?> />No 
        	<input type="radio" name="has_authority" value="1" <?= (@$info->has_authority==1)?'checked':''?> />Yes
			</td>
        </tr>
        <tr class="even">
            <td colspan="4">7.Have you ever in periods of either peace or war, been involved in the commission of a war crime or crime against humanity, such as:<br />
            	willful killing, torture, attacks upon, enslavement, starvation or other inhumane acts committed against civilians or prisoners of war, or deportation of civilians?</td>
        	<td>
			<input type="radio" name="has_inhumane" value="0" <?= (@$info->has_inhumane==0)?'checked':''?> />No 
        	<input type="radio" name="has_inhumane" value="1" <?= (@$info->has_inhumane==1)?'checked':''?> />Yes
			</td>
        </tr>
		<tr class="odd">
            <td colspan="5">If you answered “yes” to any of questions 3 to 7 above, or upon request of a visa officer, you MAY BE REQUIRED to fill out IMM 5257 Schedule 1.</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="3" align="right">Signature of Applicant or Parent/Legal Guardian’s for a person under 18 years of age.</td>
        	<td><input type="text" name="sign_name" value="<?= @$info->sign_name?>" /></td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td colspan="3" align="right">Date: YYYY-MM-DD</td>
        	<td><input type="text" name="sign_date" id="sign_date" value="<?= @$info->sign_date?>" /></td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
    </tbody>
	</table>
<!-- table end -->
</form>
              <textarea id="gogo" rows=20 cols=50></textarea>
			</div>
		</div>
		
		<?=$this->load->view('include_sidebar',array('id'=>$id,'forms'=>$forms))?>
	</div>

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$().ready(function() {
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    rules: {
		service_in:"required",
		visa_requested:"required",
		family_name:"required",
		has_other_name:"required",
		sex:"required",
		birth_y:"required",
		birth_m:"required",
		birth_d:"required",
		birth_place:"required",
		birth_country:"required",
		citizenship:"required",
		current_country:"required",
		current_status:"required",
		current_from:"required",
		current_to:"required",
		is_pre_residence:"required",
		is_same_current:"required",
		marital_status:"required",
		has_pre_married:"required",
		passport_no:{
		 required:true,
		 rangelength:[5,30]
		},
		passport_country:"required",
		passport_issue:"required",
		passport_expiry:"required",
		mailing_street_name:"required",
		mailing_city:"required",
		mailing_country:"required",
		is_same_mailing:"required",
		visit_purpose:"required",
		visit_from:"required",
		visit_to:"required",
		visit_cad:"required",
		visit_person_name1:"required",
		visit_person_address1:"required",
		has_edu:"required",
		emp_from_y1:"required",
		emp_from_m1:"required",
		emp_occup1:"required",
		emp_company1:"required",
		emp_city1:"required",
		emp_country1:"required"
    }
  });
  
	$.datepicker.setDefaults(
		{
		dateFormat: 'yy-mm-dd',
		changeMonth: true,
		changeYear: true,
		showOn: "both",
		buttonImage: "images/calendar.gif",
		buttonImageOnly: true
		}
	);
	$("#current_from").datepicker();
	$("#current_to").datepicker();
	$("#pre_from1").datepicker();
	$("#pre_to1").datepicker();
	$("#pre_from2").datepicker();
	$("#pre_to2").datepicker();
	$("#apply_from").datepicker();
	$("#apply_to").datepicker();
	$("#marry_date").datepicker();
	$("#pre_married_from").datepicker();
	$("#pre_married_to").datepicker();
	$("#visit_from").datepicker();
	$("#visit_to").datepicker();
	$("#passport_issue").datepicker();
	$("#passport_expiry").datepicker();
	$("#sign_date").datepicker();
	
	$("#email").autoMail();
	
	$("#printInfo").click(function(o) {
        alert('fff')
            var e = document.f.apply_country;
            alert(e)
            alert(e.options.length)
    
    for(var i=0; i<e.options.length; i++) {
        var s = $("#gogo").val();
        $("#gogo").val(s+"\n"+e.options[i].value);
    }
        return;
		var prints = [
			{rel_id: <?=$cateid?>, rec_id: <?=$id?>}
		]  ;
		
		var jdata = JSON.stringify(prints);
		//alert(jdata);
		$.post("<?=site_url('proxy/does/'.str_replace('==','',base64_encode('http://'.$_SERVER['SERVER_NAME'].':9090/javaprduct/servlet/test')))?>",{clients:jdata},function(msg){alert(msg)});
	});
	
	$("#printInfo").ajaxError(function(event,request, settings){
		//$(this).append("<li>出错页面:" + settings.url + "</li>");
		alert("无法访问"+ settings.url );
	}); 
    

 
});
</script>

<?=$this->load->view('include_footer',null)?>